Tracking Student Work with Learner-level Access

How to track students’ work in Aquifer case–for programs that do not have an institutional subscription with administrative and reporting tools.


If you don’t have an institutional subscription to Aquifer, your students might be using Aquifer cases via one of our individual learner-level access options, which include:

  • Free Learner-level access to Aquifer courses as part of the Aquifer COVID-19 response (offered to non-subscribing nurse practitioner, residency and international MD programs)
  • Individual subscriptions that students purchase with a credit card to access Aquifer a Signature course (Family Medicine, Geriatrics, Internal Medicine, Pediatrics, and/or Radiology).
  • Individual access to Aquifer’s five free interdisciplinary courses in High Value Care, DIagnostic Excellence, Oral Presentation Skills, Culture in Health,  and Medical Home, which students at non-subscribing institutions can access for free directly from aquifer.org. 

With learner-level access, students can easily track their own progress through cases and see their free form summary statement responses from cases through their Student Report available on their individual account–but faculty don’t have direct access to view these reports.

How Faculty Can Use the Student Report To Track Student Work

Faculty and administrators that want to track student work can require your students to share their Student Report from any course with you in any of the following ways:

  • Submit a screenshot 
  • Send an export of their student report
  • Share a view of their reporting screen via video call

These reports would allow you to:

  • Verify completion of assigned cases
  • View the amount of time a student spent on a case
  • Review student summary statements (available for cases in Family Medicine, Internal Medicine, Pediatrics)
Using Summary Statements

For Faculty Using the COVID-19 Learner-level Access Only

Many Aquifer cases require students to write summary statements as they move through the case. Faculty can compare student summary statements (included in the Student Report noted above) to those written by content experts. Reviewing this content will allow you to provide your students with concrete feedback, helping them to improve their clinical reasoning in a meaningful way.

At this time, expert summary statement answer keys are available only as part of the Faculty Took Kit (sent via email) for programs using the COVID-19 Free Learner-level Access. 

Student Report Views & Case Completion Details

Student Reports are available for any course available in your students’ Aquifer accounts. The Student Report includes the following information on each case in the selected course:

  • Case Number
  • Time from Case Start to Complete (Total active working  time in hours, minutes, seconds)
  • Percent Case Completed, shown as:
    • Case Complete = Green Check Mark
    • Case Partially Completed = Yellow circle showing the percentage of the case complete – Note: the percentage is NOT a grade or score!
    • Case Not Started = Red Circle
    • Case Reset = Any color circle with a black outline
  • Pages Completed
  • Start Date (local time)
  • Date Last Accessed (local time)
  • Completion Date & Time (local time displayed on screen, Eastern Time displayed in exports)
  • Case Summary statement (if applicable–not all cases require a summary statement)
  • Case Reset Status (whether a student chose to go back and re-do the case again–showing only the work from the most recent case review)

The on-screen Student Report looks like this:

The export of the Student Report looks like this:

How can I tell my students to access reporting?

We have a complete how-to article for students in our Reporting for Students support article. You will need to let your students know how you prefer to see the report (video call screen share, screenshot, or sending the csv export) and when their work is due.


Is there a more efficient way to track student work?

Direct access to student reporting is available with Aquifer institutional subscriptions.   Should your program decide to purchase an Aquifer institutional subscription in the future, you would have access to this functionality.

FAQ’s: Aquifer Addiction is Becoming CARE

Effective July 1, 2020, Aquifer Addiction is known as CARE (Course on Addiction and Recovery Education) and is distributed by Aquifer on behalf of Hazelden Betty Ford Foundation (HBFF) and NYU Grossman School of Medicine.   

The CARE course will move from the Aquifer teaching and learning platform (Aqueduct) to be hosted on the updated NYU Grossman School of Medicine learning platform (along with WISE-MD and WISE-OnCall) on September 2, 2020. Please note that the NYU platform launch date has been extended to ensure the best possible user experience.

No, the course content will stay the same. Currently, Hazelden Betty Ford Foundation is planning to develop 6 additional cases to add to the course in the future.

Here is a preview of the CARE user experience in the new NYU learning platform:

CARE will still be distributed by Aquifer, and the price for the 2021 subscription year will remain unchanged from the 2020 subscription year. Please contact your Aquifer Relationship Manager with subscription questions.

Faculty and students will continue to sign in to their Aquifer account to access CARE.

From July 1 to September 2: CARE (formerly Aquifer Addiction) will appear in your course list on your Aquifer course page. All faculty and students should access cases through this course.

After September 2: From the Aqueduct “Courses” landing page, users will click on a new blue “CARE” button at the top of the page to connect to the NYU learning platform, where they will be able to access CARE course content.

Students rostered to Aqueduct will continue to have automatic access to CARE along with their other Aquifer courses. No change in rostering will be required.

Aquifer Addiction cases completed in Aqueduct will not be available in Aquifer reporting as of September 2. Please be sure to download student progress reports you wish to save for Aquifer Addiction prior to September 1, 2020. Please contact your Aquifer Relationship Manager with any questions.

The new NYU Grossman School of Medicine learning platform will provide student progress reporting for course work completed in the new platform, but work in Aquifer Addiction cases that students have previously completed in Aqueduct will not transfer to the NYU learning platform. Student work previously completed will not be visible in new reports, and students who wish to review previously completed work will have to click through the content again.

From July 1 to September 2, we do not recommend including CARE cases in custom courses. Please be advised that this feature–and those listed below– will not be available once CARE transitions to the NYU platform. All cases can be accessed directly from the “CARE (formerly Aquifer Addiction)” course on your Courses page.

As of September 2, CARE cases will no longer be:

  • Included in Aquifer custom courses. If an Aquifer Addiction case is currently included in a custom course, that case will disappear from the custom course and the reporting for that custom course after September 2. 
  • Available and searchable through the Aquifer Case Library.
  • Available via Aquifer’s iOS and Android mobile apps. 

The Aquifer Addiction course was originally developed under the Course on Addiction Recovery (CARE) brand by the Hazelden Betty Ford Foundation in collaboration with Treatment Research Institute (TRI),  the American Society of Addiction Medicine (ASAM), and Aquifer (formerly known as MedU) to encourage more participation in Addiction education.  

When MedU changed its name to Aquifer in 2018, the CARE course became Aquifer Addiction and was adapted to be available on Aqueduct, Aquifer’s new teaching and learning platform.  

Unlike other Aquifer signature courses, the Aquifer Addiction course is maintained by the Hazelden Betty Ford Foundation and not currently supported and updated by the Aquifer Consortium of Medical Educators. Returning the course to its original CARE brand helps us to better align to Aquifer’s brand promise that all our signature courses are maintained and updated by our consortium of medical educators. 

Moving CARE to the NYU Grossman School of Medicine’s learning platform aligns it with WISE-MD and WISE-OnCall, the other courses Aquifer distributes on behalf of partners, and allows Hazelden Betty Ford Foundation to advance the course content and mission independently.  Currently, HBFF is planning to develop 6 additional cases to add to the course.


Who should I contact with questions?

NYU will be responsible for course functionality and reporting maintenance and support. Please contact the NYU support team with questions.

Hazelden Betty Ford Foundation will now be responsible for maintaining course content.

Aquifer will continue to manage subscriptions and course access for your program. Please contact your Aquifer Relationship Manager with questions about subscriptions, or Aquifer support for access issues.


We are committed to supporting you and your learners through this transition to the new course system and learning platform. If you have questions about the transition, please contact your Aquifer Relationship Manager.

Program Case and Course Usage Report Corrections

On December 16, 2019, Aquifer implemented a fix to correct an error that affected our program-level summary report data prior to November 19, 2018, including data found on some of our Program Case Usage and Program Course Usage reports. In some cases, the aggregate case usage was overstated on these reports. The error has now been corrected.  Please note that individual student case completion status was not affected.

Which reports were impacted?

The error impacted only certain reports which present aggregated historic case usage at a program level, including:

  • Program Case Usage and Program Course Usage reports
    • Generated between November 19, 2018, and December 12, 2019
    • AND Include  student activity before  November 20, 2018

Program Case Usage and Program Course Usage reports are available to faculty and administrators who hold the roles of Program Service Administrator and Curriculum Administrator in your Aquifer account.

None of the following data or reports were impacted:

  • Student level case completion data
  • Program Case Usage and Program Course Usage reports containing student activity data anytime after November 19, 2018
  • Program Case Usage and Program Course Usage reports pulled after December 11, 2019 or before November 19, 2018

What is the impact of the error?

Aggregate case usage in these impacted historic reports for particular time ranges may have been overstated. The cases completed which displayed initially were in fact completed by your students, but not during the date range specified in the report.

Please note that student case completion status (case completed, not completed, or in progress) were not affected by this error.


Why does this matter to me and what should I do about it?

Your historic total aggregate program case usage as represented by these reports during key data ranges may have been inaccurate.  If you are using these previously pulled reports to compare year to year usage of Aquifer cases, or to make other decisions, you should regenerate these reports to access the now corrected data.


Where do I find the reports that were impacted?

Program Course Usage Report

The Program Course Usage report is accessed by Program Service Administrators or Curriculum Administrators from your Programs page.

PROGRAM COURSE USAGE REPORT
PROGRAM COURSE USAGE
Aquifer-Case-Usage-Report

What if I have additional questions?

If you still have questions, please contact Aquifer Support. As always, our team is dedicated to assisting you in any way we can to ensure that you have the best possible experience with Aquifer’s teaching and learning tools.

We sincerely apologize for this error and any issues this may cause for your program. We know that you rely on the accuracy of Aquifer reporting and we are committed to maintaining your trust in our courses and platform.

Support Ticket

We’re here to help.

If you’ve reviewed our resources and tools and still need tech support, please complete a support ticket here.

Please provide as many details as possible about your issue.

Support Hours:


Recent Issues

Confused by Time on Case Reports?

Our time from case start to complete calculations are now more accurate. Calculations have improved to bring you a time on case measurement that more closely reflects the time spent engaging with case content. This does not calculate the time the case is open in a browser and will time out due to inactivity.


Would you rather speak directly to our support staff? View our contact information.

Educator Guides & Resources Available

Aquifer’s Educator Guides are your complete guide to using—and making the most of—Aquifer courses in your program. The Educator Guides are ideal for educators who are looking to:

  • Start using an Aquifer course as a new staff member or new subscriber
  • Discover best-practices and new ideas for integrating Aquifer into your course or curriculum
  • Take advantage of the many free resources included with Aquifer
  • Catch up on the latest features, Educator Resources, and assessment options available
  • Access a quick reference guide to all of the cases, resources, and features

Key Features

All Educator Guides include:

  • Course overview and pedagogy
  • Integration strategies
  • Features overview (searchable Case Library, custom courses, and more)
  • Resources included with your subscription (free courses, Aquifer Sciences Curriculum Database)
  • Support resources
  • Case details (Case Synopses, Learning Objectives, clinical locations)
  • Direct links to any course-specific additional resources and tools

Educator Guide Library

We currently offer Educator Guides for the following courses. To access the guides, please see the details below—you will need to sign in to your Aquifer account.


Additional Resources

Our Educator Guides include direct links to additional course-specific teaching and learning tools created by the Aquifer Educators Consortium. These tools are fully developed, available for download, and ready to use in your teaching. Currently, our additional resources include:

User Story Videos

Hear from top educators around the country who are using Aquifer to provide consistent clinical experiences, complete coverage of national curriculum standards, self-directed learning, and remediation opportunities for their students. User Story Videos are available for each Aquifer course.

EXPLORE USER STORY VIDEOS


Accessing Educator Guides & Resources

Sign in to your Aquifer account in Aqueduct, our learning management system.

From your Courses page, click on the green Educator Resources bar.

The Educator Resources page shows all of the resources available for your program’s subscribed courses and free interdisciplinary courses. Click on resources for your desired course to view and/or download resource files.

Searchable Case Library

video


Searchable Case Library

You can now search and filter the Aquifer cases available to you with your program’s subscription—plus Aquifer’s five free cross-disciplinary courses—to quickly select the cases you need.

Our new searchable Case Library page, accessible from the main navigation menu for all administrative users, is home to the advanced case search—and our updated detailed case list display.

The advanced case search includes a series of dropdown filters which allow you to view cases by:

  • Presenting Problem
  • Final Diagnosis
  • Additional Diagnosis
  • Aquifer Signature Course
  • Age Group
  • Clinical Focus
  • Other Clinical Discipline
  • System
  • Clinical Location

You can also use the Search field to conduct a keyword search, which includes text in the case titles, case synopses, and learning objectives.


Detailed Case List Display

With our new detailed case list display, you can also view key information—including case synopses, learning objectives, and cases summaries—with one click to help you choose cases that fit your needs. Aquifer cases are authored and continuously updated by the expert healthcare educators who make up the Aquifer Consortium. Case authors and the date the case was last updated are now displayed for each case—so you can be sure your students are being provided up-to-date content written by your trusted peers.

You can also access all cases directly from this page by clicking on the case title. As an administrative user, you will have ungated access to the cases, so that you can access all content at once without answering questions as you advance.


Put Your Cases to Work

Once you have selected the cases you need, you can create a custom course directly from the Case Library page. You can choose cases to assign to students to prepare for or review key clinical situations or concepts.

Sign In to Aqueduct

1. Go to Aquifer.org and click Sign In in the top right corner. This will take you to Aqueduct, our learning management system.

2. Enter your institutional email address in the Email box. Then click on the Register button at the bottom of the page. If you receive a prompt on the screen stating “Please ensure you are using your institutional email. If registration issue persists, please contact your clerkship coordinator.”  you may be using the wrong email address, or your email may not have been rostered in the system by the administrators at your program.   Try to register again using your official institutional email.   If you are not successful you will need to contact your course director and ask to have your email added to the system.

Note: If you have previously registered, you will receive a notification that you have already signed in and you will be re-directed to the sign-in screen.

3. You will be sent an email with a link to complete registration. Upon receipt of the registration email, click on the link “Click Here“. You will then be brought to the profile setup page.

4. You will be asked to fill in your profile information and set up a password (8 character minimum).Once you have completed your user profile and created a password, you will receive a welcome email with links to useful information and guides. You would also be logged into the Aqueduct learning management system.

After Completing Your Registration

1. Once you have completed your user profile and created a password, your sign in will be quick and easy. Go to Aquifer.org and click Sign In in the top right corner.

2. You will then be brought to the Aqueduct sign in page. Please log in with your institutional email and account password and click “Sign In”.

5. Once your profile is completed successfully, you will be brought to your institution’s Course page.

Now your sign in will be quick and easy. Go to Aquifer.org and click Sign In in the top right corner, then enter your institutional email and password.

If you experience an issue during Sign In, please allow a few minutes for it to resolve. If the issue persists, please contact Support.

Duplicate Courses to Create a New Custom Course


Save time creating custom courses with our new Duplicate Course feature. You can copy all the cases and/or users from an existing course into a new custom course in just a few quick steps. Any course—including existing custom courses and Aquifer signature courses—may be duplicated. Once you’ve created the new custom course you can give it a new name and description, and edit it further by adding or removing cases and users at any time.

1. From your courses page, select the course with the set of cases and/or users that you want to copy.


2. Once you are in a course, click the Duplicate Course button on the right-hand side.

3. On the Duplicate Course page, enter:

Course Name: We suggest using a consistent naming convention that includes course and rotation name, such as “Family Medicine Clerkship: Block 4”.

Description: We suggest including instructor name, instructions for the course, which cases are assigned, due date, and anything else your students need to know.

Person Responsible: Select the user responsible for the course from your list of eligible administrators. The person responsible will be visible on the course page to all students and administrators associated with the course and will be notified when the course reaches its end date to either delete or extend the date of this course.

Start Date: Visible to all course users.

End Date: This date will show on the courses page for all associated users. When the end date is reached, the person responsible for the course will be notified and asked to delete or extend the date for this course.

Copy Users: Check the box to copy the users from this course to your new course, making it easy to assign new cases to the same group of students and administrators. You can edit the list of users later in this process (and at any time) if there are changes to the roster or staff.

Copy Cases: Check the box to copy the same set of cases for your new course. It’s easy to assign a new group of studetns and administrators. You can add and remove cases at any time.

Once you are done, click “Create Course” to create the new course.


4. You will then receive a notification of successful course creation. If you did not copy any users, you will return to the Course page.

If you checked the box for “Copy Users”, you will see the screen below. Your copied users will appear automatically in the email addresses field. Check the box to send an email invitation to users. You can select a later date, or send immediately by selecting today or leaving the date blank.

Note: You can edit the email list on this screen to add or remove users. You can also add or remove users from the course later (see below).


5. From your new course page, you can add or remove users and cases at any time. Learn how to add or remove users and cases.

Editing & Removing Custom Courses

Custom courses are completely flexible and simple to change to meet the needs of your program or students. It’s easy to edit a custom course if you need to update your information or add or remove cases and users assigned to your course at any time.

After your course ends, please help keep your program’s course list current by removing your old courses after you have downloaded the reports you need.

Editing Custom Courses

Note: Course reports always reflect the students and cases assigned as of the date you are accessing the report.

You can edit any of the information that appears on the Courses page about a custom course (name, description, start date, end date, and person responsible) at any time.

1. From the course page for the course you wish to edit, click the Edit button on the top right side.

2. Update the information you wish to change, and click Update Course.

If you need to add cases to an existing custom course:

1. Open your custom course and click Add Cases.

2. You’ll see a simple list of cases. Use the search field to type in case names to quickly find the cases you want to add, or scroll through the list of cases available to you. Click on the cases you want to add, or use the Select All Shown and Deselect All buttons to select your cases.

3. Click Add in the upper right-hand corner. After adding cases, you’ll return to your course page and will see the new cases added to the list.

Note: To take advantage of the advanced case search to choose the cases you wish to include, we suggest opening the Case Library page (click on Case Library in the top navigation) in a separate tab to browse available cases. You can use the search and display features to make a list of the cases you wish to include, and then return to the Add Cases to Course page to select those cases and add them to your course.

Remove Cases from a Custom Course

1. From your custom course page, click Remove Cases.

2. You’ll see a simple list of the cases included in your course. Select the cases you wish to remove and click the Remove button in the upper right-hand corner.

Add Users

There are two options to add users to a custom course. Please see the Creating Custom Courses instructions for details.


Remove Users

Removing users from a custom course will discontinue their access. Students who are removed will no longer appear in the course report. Be sure to download any needed reports before removing students.

1. From the course page, click Course Users.


2. Select the user/s you wish to remove from the course from the list. Use the search field to search by first name, last name, or email address to find your user/s quickly.

3. Click Remove Selected Users.


4. You will see a pop-up message asking if you are sure you want to remove the users. Click OK.

A confirmation message will appear in the light blue bar at the top of the page if your users were successfully removed.


Remove a Custom Course

Help keep your program’s course list current by removing old custom courses. To help you manage this process, the person responsible for each custom course created after August 3, 2018 will receive an email notification when the course end date is reached asking them to extend the date or remove the course. Any user with the role of Program Service Administrator, Curriculum Administration, or Course Administrator can remove a course.

Please be sure that ALL course users no longer need to access the course and all associated reporting before removing a course.

To remove a course you—and all other course users—that no longer need to access, proceed through the steps below.

1. Be sure that you have downloaded and saved any reports that may be needed from this course. Reporting is not available for this course after it has been removed.

2. To remove a Custom Course, click on the course you want to remove. From the course page, click the Remove button on the right side.


3. You will receive a popup warning message. Click OK and the course will be deleted.

Managing & Removing Student Users


After students are added to your program, it’s easy to manage your student users in Aqueduct. Administrative users with student user management permissions (view roles and permissions) have the ability to:

  • Remove rostered students from your program
  • Export a student list
  • Send email invitations to students at any time
  • Sort and filter students in a variety of ways

At the start of each academic year, please remove students who no longer need to access Aquifer courses. This will keep your user counts accurate, make your student user list easy to manage, and keep your account up-to-date.

video

The Student User Panel

To access the student user panel, click on Users in the top navigation. From the program users page, click on the Students tab.

The top of the Student User Panel displays your student user counts at a glance. Counts include:

  • Registration Pending: the number of students who have access to your program but have not registered in Aqueduct yet
  • Active: Students who have completed their registration
  • Total: All students currently rostered in your program (both registration pending and active)
  • Max: The maximum number of students that may be added based on your institution’s current subscription
student user panel

Below your student statistics, you’ll see a full list of your students with a variety of options for filtering, sorting and selecting. You will also see Send Email Invitation, Export User List, and Remove Selected Members buttons. These three options are inactive until users are selected

There are a variety of options available for sorting your student list. You can Search by last name, first name, or email address in the search field (1).

You can also sort in ascending or descending order by date added, first name, last name, email, or anticipated graduation date.

Please note first name, last name, and anticipated graduation date is entered by the students when they complete their registration status and will not be available for students who have a status of “registration pending”.

To sort, click on the button for the field you wish to select (2). The button you select will turn a darker blue while your sort is active, and a pointer will appear next to the text indicating if your list will be sorted in ascending or descending order (3). Click the button again to change the sort order.

student user panel sort and filter options

Aqueduct’s user panel allows you to Filter by Status. Use the dropdown menu to sort the list of students below by registration status.

In order to use the student user management tools, you will need to select the group of students you wish to manage. After using the filter and sort options to display the list of students as you’d like, there are two methods to select and deselect students.

  1. Use the Select All Shown or Deselect All buttons above the list.
  2. Check the box next to each student you wish to select. Check the box again to deselect the student.

Selected students are highlighted, and show a checkmark in the box next to their name.

student user select and deselect options

Student User Management Tools

Managing your student users is easy with the ability to send email invitations and export user lists.

Administrative users can send email invitations to students with a Registration Pending status only. It is recommended to re-send email invitations to students who have not logged in after several months (or a length of time that matches the needs of your program) to ensure that students are making use of their Aquifer courses.

To send an email invitation, select the students you wish to email, and click the Send Email Invitation button.

student user tools - send email invitation

You will receive a pop-up prompting you to confirm that you wish to send an email to the selected students. Click OK to continue sending the email invitation.

student user email invitation message

After emails are successfully sent, you will see a confirmation note in the box at the top of the page.

student user email invitation success message

Please note: Emails will not send to students with an Active status. If you select students with a mix of statuses, emails will send to only those who have not yet registered. After clearing the pop-up, the message at the top of your screen will show which emails were sent to students.

To export a list of users to a csv file, select the students you wish to export and click the Export User List button. Your browser will direct you to download and save the csv file for your use.

student user export list

Removing Students from Your Program

Removing students from your program will discontinue their access to your Aquifer courses.

Warning: Download Reports Before Removing Students

Be sure to download any and all reporting associated with the student/students you are planning to remove. Once removed, a student’s coursework will not appear on the case or course reports.

There are two ways to remove students from your program.

To batch remove students using a list of email addresses, click the Remove Students button at the top of the page.

remove student users buttom

On the Batch Remove Students from Program page, add the student emails (comma separated) that you wish to remove from your program and click Remove Students.

batch remove students from program

You will receive a pop-up message asking to confirm the removal of the listed students. Click OK to confirm that you wish to proceed.

student batch remove warning message

After the process completes, you will see a confirmation in the notification bar at the top of the page.

student batch remove confirmation

You can also remove students by selecting them from the student user list, and clicking on the Remove Selected Members button. This method is recommended for individual or small groups of students.

remove selected student users

Like the batch removal process, you will see a pop-up notification asking you to confirm deleting the selected students. Click OK to continue.

Remove selected students popup message

After the process completes, you will see a confirmation in the notification bar at the top of the page.

student batch remove confirmation

Note: When students are removed from a program, they are automatically added to the Aquifer Alumni program. From the Alumni program, they will be able to access Aquifer’s free course content or purchase an individual subscription or continuing education module.

Student Learning Resources: Now in Aqueduct

Aquifer’s Student Learning Resources—available to all users—are easily accessible in Aqueduct. There are two types of Student Learning Resources: general and course-specific.

General Student Learning Resources

To access the general resources, sign in to Aqueduct and navigate to the Courses page. If you don’t land on the Courses page, click on Courses in the top navigation bar.

Click on the pink Student Learning Resources to access the available resources.

What Resources are Available?

The general resources section includes Clinical Practice Guidelines and Pediatric Developmental Milestones.

The Clinical Practice Guidelines include Hypertension and Cholesterol Guidelines, available in collapsible sections.

Each guideline is available for download as a pdf at the bottom of the resource.

The Pediatric Developmental Milestones tool is an interactive table with videos for each milestone.

This section also includes a video guide to the interactive table and a downloadable pdf.


Course-Specific Student Resources

Additional course-specific Student Learning Resources are now available from within their courses: Aquifer Culture in Health Care and Aquifer Medical Home. The resources appear on the Cases page and are grouped by topic.

Topics include Cultural Awareness, Medical Home, Navigating the Healthcare System, On Language, The Physician’s Role, and Caring for Children & Youth with Special Health Care Needs.

Aqueduct System Requirements

Aquifer’s teaching and learning platform, Aqueduct, is built using web standards, the program runs on Windows, Mac, Linux, iOS, Android, or any other device with a modern web browser.


Supported Operating Systems include: Windows 7 and newer; Mac OSX 10.6 and newer; Linux; ChromeOS

Mobile Operating Systems: iOS – please install our app for iOS 10 and newer; Android – use Chrome web browser for Android 4.4 and newer

Computer Speed and Processor: Best experienced on a computer 5 years old or newer; 1GB of RAM; 2GHz processor

Browsers Supported: Microsoft Edge; Safari 9 and newer (Macintosh only); Chrome 55 and newer; Firefox 50 and newer

New Programs: Whitelist our Domains

This is a critical step if your program is new to using Aquifer. Whitelisting our domains and email addresses will ensure that your faculty and students will be able to gain access to our system.

Whitelisting should be done by your program’s IT department.

Web Traffic

Email from the Aqueduct learning platform

  • Domain:  delivery.meduapp.com
  • IP:  149.72.67.97

How To Update My User Profile

You can update your User Profile while you are logged in. You will be able to change your First Name, Last Name, Professional Degree, Your Program Role, as well as other role specific options.

Note: Some of the profile options are only available to certain Aqueduct Roles.

1. Sign in to Aqueduct.


2. Once you are logged in, click on the “My Profile” link in the top navigation bar.


3. You will then be brought to your profile administration page. Here you can update your information to make it current. Once you have updated your information, click on “Update”.


4. You will then see a notification for successfully completing your profile.


 

How To Change Your Password While Logged In

It is possible to change your password while you are logged into Aqueduct.

Note: Your new password must be 8 characters or longer. You can use a combination of uppercase, lowercase, numbers and symbols.

1. Log into Aqueduct.


2. Click on My Profile.


3. You will then be brought to your profile administration page. Click on “Edit Password“.


4. You will then be brought to a password update page. Put in your new password under “Password“, put your new password in a second time to confirm under “Password confirmation” and finally put your current password under “Current password“. Now click “Update” to update your password.


5. You will then be notified that you have successfully updated your account (password).


 

How To Access Another Program If You Are Part Of Multiple Programs


Some users have access to multiple programs in Aqueduct. You can switch between these programs easily to run your administrative duties.

1.Go to Aquifer.org and click Sign In in the top right corner.


2. Click on the Programs link in the top navigation bar.


3. You will then see a list of all of the programs you have access to. Click on the program you would like to access.


 

How To Resolve “Invalid Token” Error

If you are registering for Aqueduct and you receive an “Invalid Token” error when trying to set up a new password, please try copying and pasting the link from your email into Chrome, Firefox, Internet Explorer or Edge. We currently have a bug in Safari that will give an “Invalid Token” error. We are working to get this resolved as soon as possible. If you still are having issues, please submit a ticket using the following link: Aquifer Support


 

Sign in to WISE-MD or WISE-OnCall

1. Go to Aquifer.org and click the Sign In button.


2. You will be brought to the Aqueduct Sign In page. Put in your account email address and password. Then click Sign In.


3. On the top navigation bar, click on Courses.


4. You will then see blue buttons on the right. One for logging into Wise-MD and one for Wise-OnCall. Click the button to access one of the sites. You will be brought to another page and be logged in.


5. If this is your first time accessing WISE-MD, you will be brought to a verification page which will ask you to confirm your name, institution, and to select your appropriate clerkship/group/block. Minimally, you will see a default clerkship/group/block; if you see more than one option, chose the most appropriate one.

NOTE: This only applies to WISE-MD and does not apply to WISE-OnCall.

Accessing WISE-MD Reporting

Quick Reference Guide for WISE-MD Reporting

Via Aqueduct, Aquifer’s Learning Management System
  1. To access WISE-MD reports, click on the “Launch WISE-MD Reports” button at the top of the Course page for your program in Aqueduct.

2. The WISE-MD Administrative Control Panel will launch.

NOTE: From here you will be able to look at individual progress reports by learner and user activity details which will be the two most useful means of checking for completion on a particular assigned module.


Types of Reports Available to Administrators and Educators

Individual Progress Reports: student specific – these reports show the details of module complete by section, providing the date/time the student completed each section of each module.

Group Reports

User list: generates user list based on time frame entered; shows student’s name, username (email), date account was created and which program they belong to

User Activity: generates completion overview for each module by student within parameters specified by faculty user (date accounts were created and activity date range). The 8/8, 9/9, etc numbers show how many sections of the module the student completed.

User Activity Detail: Composite report of individual progress reports; shows dates and times that the student started and completed sections of a module; completed sections are denoted by green boxes.

Usage Overview: generates overall reports of how WISE-MD is being used; does not differentiate between unique users so if a student access the same module more than once, however many times the student accessed the module will be counted

Please note: The assessments in WISE-MD are self-assessment only and are not designed to be used for grading purposes other than completion, i.e. you completed the questions, you get a Pass.

Learner Facing Reports: The case questions are meant to guide learning and the students are able to redo the questions as many times as they need to in order to determine the correct answer. The student receives immediate feedback on the question (whether it is correct or incorrect) along with explanations. Our database records and keeps the last attempt at questions and students have the ability to keep track of their performance on questions based on their last attempt.

This Module Question Summary does not tell them which questions they answered right or wrong. This simply summarizes the correct and incorrect # of responses based on their best attempts.

***Faculty interested in noting completion of these questions can ask the students to screenshot their Module Question Summary and that image/file can be uploaded ***

Resetting Student Cases


As of January 2, 2019, students may reset their own cases at any time to review Aquifer cases again in a rigorous way. Please note that individual programs or courses may have specific policies on this function. Administrators can no longer reset student cases.

A Case Reset means that:

  • All progress in the case will be cleared and reset. Previous data will not be available.
  • Students will need to re-take the case to record a completion.
  • Faculty and administrators can view each case reset in their reports.
  • On Student Reports, a black outline will show around the circles indicating progress on the cases that have been reset.

Why Reset a Case?

A student may wish to reset a case to complete it again in a complete way, revealing information step-by-step as they move through the case and answering embedded assessment questions. Although the case content is available to students after case completion, the information will appear all at once (ungated) and questions will show previous answers. Resetting the case will remove all previous data, allowing students to repeat the original case experience.

Download Case Notes

Before resetting a case, be sure to download any notes that you’ve saved in Aqueduct. There are two ways to do this:

  • To download case notes ONLY in a csv file, select cases below and click the Download Case Notes button on the Case Reset page.
  • To download Case Summaries with your notes included, return to the end of the case(s) and click Download Case Summary.

How to Reset a Case

1. Select the course that contains the case(s) that you would like to reset.

2. From the course page, the progress bar next to each case indicates your current progress.

  • If you want to download the Case Summaries with your notes included from your completed cases, return to each case and download the case summary at the end of your case.

3. Click on the Case Reset button.


4. Select the case(s) that you wish to reset. Selected cases will show in blue. You may also use the search field for Select All or Deselect All to quickly choose your cases. Note: If you need to download your case notes, click the Download Case Notes button.


5. Click on the Reset Cases button. Two warnings will come up to ensure that you wish to continue and that you have downloaded your notes. Click OK twice to reset your cases.


6. After resetting, you will land on the course page where you will see that the progress bar for your reset cases has been updated to show 0%.

Building Clinical Reasoning Skills

Building Clinical Reasoning Skills

Research shows that physicians who are able to provide a semantically rich summarization of a case are much more accurate in making a clinical diagnosis.

Teaching clinical reasoning is one of Aquifer’s foremost educational goals. In following a virtual patient from presentation to outcome, students hone their skills in recognizing and interpreting clinical signs and symptoms. Each of our cases follows a structure that highlights the components of clinical reasoning––from gathering knowledge of the patient’s history and risk factors to making an informed opinion of the patient’s clinical status to developing a differential diagnosis, selecting diagnostic studies, and implementing a management plan. Through active engagement your learners can use deliberate practice to cultivate their clinical reasoning skills.


How is clinical reasoning learned?

Contribution by Valerie Lang, MD, MHE

Medical knowledge is essential, but insufficient, for effective clinical reasoning. Students need to organize their knowledge in a way that allows them to identify and solve clinical problems. (Norman, Charlin, et al.) The “dual-processing” model of clinical reasoning identifies two processes: Type 1 (fast, “instinctive,” heuristic) and Type 2 (slow, analytical). (Norman) There is much debate over which type is more error-prone (Norman, Eva, Croskerry), but it is generally acknowledged that experts use Type 1 reasoning when faced with problems in their field, but switch to Type 2 reasoning when faced with unfamiliar problems. Novices tend to use Type 2 but tend toward Type 1 reasoning as they develop experience. (Norman, Eva, et al.)

To develop skills in clinical reasoning, students need deliberate practice applying their knowledge to clinical cases (Eva, Norman), either virtual (e.g. paper, on-line, standardized patient) or real (e.g., patient care), and have the opportunity to reflect on the diagnostic and treatment decisions they make. Real clinical experience is essential, but idiosyncratic. Students may not encounter patients with the ideal breadth of conditions or at a stage of their illness that is most helpful for developing reasoning skills. With the increase in hand-offs in inpatient settings, students are more likely to meet their patients after a diagnosis has already been established. The lost opportunity to evaluate “fresh” patients is associated with decreased learning. (Lang)

How do Aquifer cases help students learn clinical reasoning?

Aquifer cases provide students with the opportunity for deliberate practice in clinical reasoning. The context in which clinical reasoning is learned is important. Students are more likely to correctly solve a case if it is presented in the same context in which it was learned. (Durning, et al.) The real clinical environment is highly complex and data-heavy, and can cognitively overload the novice learner. (Merrienboer) By providing an authentic clinical and social context for cases, while reducing the amount of cognitive overload, Aquifer virtual patient cases give students a robust opportunity to develop their clinical reasoning skills in a setting that is specifically designed for their level.

Most of the Aquifer virtual patients present with an undifferentiated complaint or lab abnormality, such as cough or anemia. Students practice identifying the key findings from the history, physical exam, and test data. They synthesize the case into a concise summary statement, identify a differential diagnosis, and learn the relative diagnostic value of each of the key findings. They make decisions about what tests and treatments are important for identifying and resolving the patient’s problem. At each step, they must commit to a decision, then receive feedback and explanations about the correct and incorrect responses. This provides practice in a safe, but interactive environment. It gives students a framework to approach real patients with similar problems in a more sophisticated manner. (Edelbring, et al.)

Norman G. Research in clinical reasoning: past history and current trends. Medical Education 2005;39:418-27.

Liaison Committee on Medical Education. Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. May 2012.

Charlin B, Boshuizen HP, Custers EJ, Feltovich PJ. Scripts and clinical reasoning. Medical Education 2007;41:1178-84.

Boshuizen HP, Schmidt HG. The development of clinical reasoning expertise. Clinical Reasoning in the Health Professions2008:113-21.

Norman G. Dual processing and diagnostic errors. Advances in Health Sciences Education: Theory and Practice 2009;14 Suppl 1:37-49.

Norman GR, Eva KW. Diagnostic error and clinical reasoning. Medical Education 2010;44:94-100.

Croskerry P. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Advances in Health Sciences Education 2009;14:27-35.

Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Medical Education 2007;41:1140-5.

Lang VJ, Mooney CJ, O’Connor AB, Bordley DR, Lurie SJ. Association between hand-off patients and subject exam performance in medicine clerkship students. Journal of General Internal Medicine 2009;24:1018-22.

Edelbring S, Dastmalchi M, Hult H, Lundberg IE, Dahlgren LO. Experiencing virtual patients in clinical learning: a phenomenological study. Advances in Health Sciences Education: Theory and Practice 2011;16:331-45.

Koens F, Mann KV, Custers EJ, Ten Cate OT. Analysing the concept of context in medical education. Medical Education2005;39:1243-9.

van Merrienboer JJ, Sweller J. Cognitive load theory in health professional education: design principles and strategies. Medical Education 2010;44:85-93.

Meeting LCME Standards with Aquifer

Aquifer helps you meet many Liaison Committee on Medical Education (LCME) Standards, particularly those related to ensuring equivalent educational experiences across teaching sites, providing deliberate practice in clinical reasoning and providing feedback on student performance. Our consortium members work with schools through personalized consultations to assist in identifying how Aquifer can help meet accreditation standards.

View LCME Accreditation Standards 2018-19


LCME 6.2 Required Clinical Experiences and 8.6 Monitoring of Completion of Required Clinical Experiences

6.2: “The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility.”

8.6: “A medical school has in place a system with central oversight that monitors and ensures completion by all medical students of required clinical experiences in the medical education program and remedies any identified gaps.”

Enhancing the range of clinical encounters

In addition to caring for real patients, like Aquifer’s are considered by the LCME to be an acceptable clinical learning experience. However, if the cases are to “count,” students should be given independent learning time to work through them, and the content of the cases should be integrated into the clerkship curriculum in methods similar to patient care (i.e., didactics, bedside teaching, etc.).

There are numerous ways to classify the spectrum of patients to be seen, including:

  • Ages/developmental stages
  • Types of illnesses
  • Systems-based categories

Aquifer cases can be similarly classified and then assigned to students.

There are several suggested methods for assigning cases, including:

  • Assign cases at the beginning of the clerkship. All of the cases can be assigned, or a subset of specific cases to prepare students to see patients with conditions they are likely to encounter, or to fill known clinical gaps.
  • Assign cases individually as needed mid-way through the clerkship, based on a review of each student’s clinical logs.
  • A combination of both.
Documentation Method

Aquifer automatically creates a log of students’ completion of virtual patient cases. The Student Report for Administrators and Managers shows the detailed progress of an individual student in each case in a course, including:

  • The cases the student has completed, partially completed, or nor yet not begun
  • Time from Case Start to Completion
  • Additional details on Date the Case was Started, Completed and Last Accessed
  • Summary Statements submitted by students for cases that require them

A program service administrator, curriculum administrator, course administrator and course manager can each access this report and view real-time data on student progress.


LCME 5.5 Resources for Clinical Instruction

“A medical school has, or is assured the use of, appropriate resources for the clinical instruction of its medical students in ambulatory and inpatient settings and has adequate numbers and types of patients (e.g., acuity, case mix, age, gender).”

Aquifer’s cases were built explicitly on a generalist foundation: the nationally accepted core clerkship curriculum for each discipline. Each case models a general approach to a broad range of problems, acuity levels, ages, genders, and ethnicities. In addition, the Aquifer cases include evidence-based references and multiple Web links to practice guidelines and other appropriate resources. Integration of basic science information is included where relevant. Peer review and ongoing maintenance of the cases by our editorial boards ensures an up-to-date and well-accepted approach to the work-up and management of these common problems.


LCME 8.7 Comparability of Education/Assessment

“A medical school ensures that the medical curriculum includes comparable educational experiences and equivalent methods of assessment across all locations within a given course and clerkship to ensure that all medical students achieve the same medical education program objectives.”

Aquifer cases provide comparable learning experiences across training sites and times of year. Because the cases and exams are available on the internet, students have access to them from all training sites, facilitating student placement in rural or community settings.


LCME 7.2 Organ Systems/Life Cycle/Primary Care/(Prevention/Wellness/Symptoms/Signs/Differential Diagnosis, Treatment Planning, Impact of Behavioral and Social Factors

“The faculty of a medical school ensure that the medical curriculum includes content and clinical experiences related to each organ system; each phase of the human life cycle; continuity of care; and preventive, acute, chronic, rehabilitative, end-of-life, and primary care in order to prepare students to:

  • Recognize wellness, determinants of health, and opportunities for health promotion and disease prevention
  • Recognize and interpret symptoms and signs of disease
  • Develop differential diagnoses and treatment plans
  • Recognize the potential health-related impact on patients of behavioral and socioeconomic factors
  • Assist patients in addressing health-related issues involving all organ systems.”

Aquifer courses provide practice with virtual patients at all stages, from birth, through childhood and adulthood, to end of life. Several virtual patient cases address wellness and preventive care. Other cases provide students practice with clinical reasoning for common medical conditions, including interpreting abnormal clinical findings, developing differential diagnoses, selecting appropriate diagnostic tests, and developing treatment plans. Rather than providing rote, depersonalized clinical data, Aquifer virtual patients are deliberately designed to illustrate a variety of socioeconomic backgrounds in order to teach students how biopsychoscial factors interact to impact patients’ health.


LCME 7.4 Critical Judgment/Problem-Solving Skills

The faculty of a medical school ensure that the medical curriculum incorporates the fundamental principles of medicine, provides opportunities for medical students to acquire skills of critical judgment based on evidence and experience, and develops medical students’ ability to use those principles and skills effectively in solving problems of health and disease.

Aquifer patient cases are evidence-based, include references to supporting literature, and are peer-reviewed, providing students multiple opportunities to practice evidence-based clinical problem solving and receive expert-programmed feedback on their work.


9.8 Fair and Timely Summative Assessment

“A medical school has in place a system of fair and timely summative assessment of medical student achievement in each course and clerkship of the medical education program. Final grades are available within six weeks of the end of a course or clerkship.”

Aquifer Final Exam reports are scored and reported to schools within days.

Exam Support Contact

Aquifer Support Hours:

Monday – Friday 8:00am – 5:00pm Eastern Daylight Time
We will get back to you within 24 hours.

Except for the following holidays.

Student FAQ’s

1. Go to Aquifer.org and click Sign In in the top right corner. This will take you to Aqueduct, our learning management system.


2. Enter your institutional email address in the Email box. Then click on the Register button at the bottom of the page. If you receive a prompt on the screen stating “Please ensure you are using your institutional email. If registration issue persists, please contact your clerkship coordinator.” you may be using the wrong email address, or your email may not have been rostered in the system by the administrators at your program. Try to register again using your official institutional email. If you are not successful you will need to contact your course director and ask to have your email added to the system.

Note: If you have previously registered, you will receive a notification that you have already signed in and you will be re-directed to the sign-in screen.


3. You will be sent an email with a link to complete registration. Upon receipt of the registration email, click on the link “Click Here“. You will then be brought to the profile setup page.


4. You will be asked to fill in your profile information and set up a password (8 character minimum).Once you have completed your user profile and created a password, you will receive a welcome email with links to useful information and guides. You would also be logged into the Aqueduct learning management system.


5. Once your profile is completed successfully, you will be brought to your institution’s Course page.


6. You will also receive a “Thank you for registering with Aquifer” email with links to tools, resources, and Aquifer news.

Now your sign in will be quick and easy. Go to Aquifer.org and click Sign In in the top right corner, then enter your institutional email and password.

1. Once you have completed your user profile and created a password, your sign in will be quick and easy. Go to Aquifer.org and click Sign In in the top right corner.


2. You will then be brought to the Aqueduct sign in page. Please log in with your institutional email and account password and click “Sign In”.

1. If you forget your password, Aquifer can help you regain access to your courses and information right away. From the Sign In page, click the Forgot Password link.


2. You will be brought to a page where you can enter your Account email address. After entering your email address, click “Send me instructions to set my password“.


4. You will then be brought to a page where you can reset your password. Please put in your new password twice to confirm and click on “Change my password”. You will then be logged in with your new password.


3. You will receive an email with instructions to reset your password. If you do not see this email, check your spam mailbox. Follow the instructions in the email to reset your password. Click the link to reset your password.

1. Go to Aquifer.org and click the Sign In button.


2. You will be brought to the Aqueduct Sign In page. Put in your account email address and password. Then click Sign In.


4. You will then see blue buttons on the right. One for logging into Wise-MD and one for Wise-OnCall. Click the button to access one of the sites. You will be brought to another page and be logged in.


3. On the top navigation bar, click on Courses.

Cases are complete when you click the Finish Case button in the Case Summary Download section at the end of each case. Completed cases show on all reporting as a green circle with a check mark.

If you have completed the case content but don’t see the Finish Case button, be sure to complete all three required feedback questions at the end of the case. After you have completed the three feedback questions, you can access the Finish Case button and the downloadable case summary.

If you do not complete the feedback questions and click the Finish Case button, your work will show as partially completed—as a yellow circle showing the percentage complete—on Aquifer reporting for both you and your instructor.

We hope that all learners will share their honest feedback. We will review this feedback and use it to help ensure that we are offering the best possible learning materials.

Program Level Reports

 

Program Course Usage Report

The Program Course Usage report is designed to provide a high-level view into total usage of Aquifer courses by your program during a given period of time.

To access the Program Course Usage report:

1.Select Programs from the top menu navigation.

2.This will take you to Your Programs. Click the Program Course Usage button.

3.Select a date range, if desired, and click Use Date Range to refresh the report. Click on the program name (or +) to reveal the report. Note that if you’re enrolled in multiple programs, you’ll see all of your programs listed here. Select the one you wish to view.

The Program Course Usage Report includes a list of courses your program has access to, including both standard Aquifer courses (highlighted in grey) and custom courses created by your program (not highlighted). For each course, the following data is shown:

  • Number of cases in the course
  • Number of cases started
  • Number of cases completed by users in your program during the date range you selected
  • Name of the person assigned to be responsible for Custom Courses (created after July 2018)

Program Case Usage Report

The Program Case Usage report is designed to provide a high-level view into total usage of individual cases within Aquifer courses by your program during a given period of time.

To access the Program Case Usage report:

1.Select Courses from the top menu navigation.

2.This will take you to a list of your Courses. Click the Program Case Usage button.

3.You’ll see a list of your courses displayed. Click on the course name (or +) to reveal the report of an individual course. You can reveal more than one course at a time. Select a date range, if desired, and click Use Date Range to refresh the report.

For each of your courses, the Program Case Usage Report includes:

  • A case list
  • Number of cases started
  • Cases completed
  • Average time (in minutes) it has taken students to complete each case. You may hover over the ‘i’ icon on each of the columns to get a definition of the measurement.

Adding Administrative Users & Assigning Roles


Each program has complete control over how to manage administrative users in Aqueduct. The system is designed for flexibility to best fit your program’s needs. You can choose which users view reports, add student rosters, and access student data.

Before getting started adding administrative users, be sure to review the Roles & Permissions to decide which roles each staff member in your program will fill in Aqueduct.

Administrators and educators need to be added to Aqueduct before they will be able to access it, and they need to be assigned an appropriate role in the system.

video

How to Add Users and Assign Roles

Once you’ve signed in, click on Users in the top navigation.


Then you’ll see the administrative user panel. At the top of the page, you’ll see a grid that provides useful counts of how many people are in each role. All users are listed at the bottom of this page and may be sorted, filtered, and exported in a variety of ways.

The Administrators tab will be activated automatically, but please note that student users are accessed separately by clicking on the “Students” tab. Click the Add Admins button in the top right-hand corner.

admin user panel overview

Enter the official institutional email addresses for the users you would like to add to the system. To batch add users, enter a list of comma-separated email addresses for users who will share the same role. Users may also be added individually.


Once you have entered your email address(es), choose the User Role that you wish to assign to this group of users from the drop-down menu and click the Add Administrators button.


You will be redirected back to the Users page. A message will be open at the top of the page indicating whether or not you have successfully added users.


The administrators you added will now appear in the administrator user list below as “Unknown Unknown”, showing their email addresses, the role you have assigned them, and a status of “Registration Pending”. When administrative users sign in and complete their registration, their status will change to “Active” and this screen will show the values that they enter for First Name, Last Name, and Clinical Discipline.

Note: Administrative users will automatically receive an email notifying them that they have been assigned a specific role in Aqueduct, and inviting them to register in the system.

Next Steps:

 

Exam Administration & Proctor’s Responsibilities

There are many different aspects of successful exam administration. To ensure that everyone taking an Aquifer exam is able to do so effectively, we have detailed the activities that need to happen and the responsibilities of everyone participating in the exam, including Course Administrators, Proctors, your institution’s Technical Support Staff, and Aquifer Support Staff. Aquifer has also developed several tools to enhance exam administration that are provided here in one convenient location.


Note: Aquifer is allowing video proctoring for schools affected by the COVID-19 outbreak. Please view our Video-proctoring FAQ’s for more information.


Course Administrator’s Responsibilities

Course Administrators (Clerkship Administrators and/or Clerkship Directors) play a critical role in administering exams.

  • Complete our Aquifer Annual Exam Survey so we can be prepared and identify any challenges long before you need to administer the exam.
  • Secure a computer lab/testing room for each exam being administered.
  • Arrange for proctor(s) to monitor each exam. There should be one proctor for every 20-25 students, and at least one proctor in each examination room. Make sure each proctor understands his/her responsibilities and has access to the tools needed (see below).
  • Schedule technical support to be on call while each exam is taking place and make sure they are aware of their responsibilities (see below).
  • Ensure that all technology is tested in advance of administering each exam.

When planning to administer exams, please allow the following time:

  • Aquifer Pediatrics: 2.5 Hours
  • Aquifer Family Medicine: 3 Hours
  • Aquifer Internal Medicine Clinical Decision-Making Exam: 75 Minutes
  • Aquifer Radiology: 2 Hours

In addition, you may wish to plan on an additional 15-20 minutes to allow for orientation and other logistical items.

  • Schedule the exam with Aquifer by completing the Aquifer Exam Request Form. To complete the form, you will need the following information:
    • Name of the Aquifer course for which you are ordering the exam
    • School name
    • Exam start date and time (ET)
    • Request for any additional time you will need for students with academic accommodations
    • Purpose of the exam (Pre-test, Practice, Midterm, Final)
    • Primary person to contact if there’s an issue during the exam (name, email, and phone number)
    • Any special circumstances not already cited (extended length exams, special accommodations, etc.)
  • Ensure that all students taking the exam have registered to use Aquifer courses. Students who have not registered with Aquifer at least two weeks prior to the exam will not be able to take the exam.
  • Submit an Exported List of Students scheduled to take the exam from the Aquifer Reports Section.
  • Once the Exam Request Form and the Exported List of Students have been submitted, Aquifer will provide you with pre-populated student handouts that you may provide to the proctors to use for exam orientation and to disseminate logins and passwords.

Aquifer will email exam results to the Program/Course Administrator within two business days of the completion of the exam. The Program/Course Administrator will be responsible for releasing those results at his/her school.


Proctor’s Responsibilities

Aquifer requires that proctors are present during the exam to ensure that all exams are administered in a secure, proctored setting.

Note: Aquifer is allowing video proctoring for schools affected by the COVID-19 outbreak. Please view our Video-proctoring FAQ’s for more information.

Ensure a standard testing room environment, including:

  • Exam workstations in a dedicated room that can be closed off from the rest of the facility to minimize noise and outside distractions during testing.
  • Exam workstations that are forward facing with adequate spacing in order to reduce students’ ability to view another’s monitor and to ensure sufficient spacing between each workstation.
  • A designated area where students can store personal items such as cell phones, iPads, tablets, media devices, papers, books, coats, purses and backpacks. These are NOT allowed in the exam space.
  • Appropriate access to the room for people with disabilities in compliance with the Americans with Disabilities Act of 1990 (in the United States) or your country-specific requirements.
  • Proctors may also want to consider designating a separate testing room for students who have been approved for extra testing time.

Proctors should be prepared to access appropriate tools and technical support staff should any issues arise, including:

  • A dedicated workstation that has been checked for exam compatibility prior to examination day.
  • Access to a telephone with an outside line for use during the test session in case the proctor needs assistance during the exam.
  • The phone number and email address for relevant technical support staff.

Access to or a print out of Exam Troubleshooting Tips the provides suggested solutions to the most common problems that may arise during the testing session.

Proctors will fulfill duties which include:

  • Arrive at least 15 minutes before the exam session.
  • Startup institution workstations (if necessary).
  • Admit students to the exam room, ensure students do not bring phones or tablets into the room, check students off the roster, and distribute student handouts.
  • Orient students to the exam and read the following statement to students:
    “The materials used in the Aquifer examinations are the copyrighted property of Aquifer. If you distribute examination materials, by any means, including reconstruction through memorization, you are in violation of the rights of the owners. You are prohibited from communicating, publishing, reproducing, or transmitting any part of your exam, in any form, or by any means, verbal or written, for any purpose. Every legal means available to protect Aquifer examination materials and secure redress against those who violate copyright law may be pursued. If you become aware of any suspicious activity related to an Aquifer exam administration, please notify the proctor or clerkship director, or submit a report.”
  • Direct students to begin the exam at the designated time using the login and password on the student handouts.
  • Monitor the progress of all students after they launch their exams and report any issues.
  • Ensure that the exam is being monitored at all times (students should never be left alone in the room).
  • Check that each student has submitted his/her exam once they have completed the test and collect each student’s handout before he/she leaves the room.

Exam Support

If an issue arises during the exam:

    1. Contact your institution’s technical support staff.
    2. Access Aquifer Exam Troubleshooting Tips.
    3. If neither of those addresses the issue, contact Aquifer’s exam support staff weekdays 8 am – 5 pm ET, except federal holidays.   Extended support available till 7 pm ET weekdays on days when exams are scheduled.

Contact [email protected] or (603) 277-2060 with any questions about test administration activities.


Security Reminder

Please remind all faculty and students that all exam content is confidential and should not be shared with anyone, at any time, in any way.

Exam Technical Support Information

Technical Requirements

The standard Aquifer exam requirements outlined below apply to exams delivered over both wired and wireless networks. Students may use personal laptops, either Macs or PCs, to take an exam.

  • Windows 7, Windows 8, Windows 10
  • Mac OS X version v10.9 thru v10.15 (Catalina)
  • 1GHz processor or higher
  • 17” screen or larger monitor (Desktops)
  • 13” screen or larger (Laptops)
  • Minimum screen resolution of 1024×768 with
  • 32-bit color setting
  • Turn off Windows updates or virus scanner updates to avoid interruptions during the exam.
  • Virtual machines and applications are not guaranteed to work; prior testing on your system will be required.
  • Tablet devices are not currently supported devices. This includes iPads, Android tablets, phones, Windows touchscreen/tablet computer and Microsoft Surface. Touchscreen laptop computers may work, provided you use a mouse or a trackpad and the keyboard and do not use the touchscreen. You are strongly urged to test the use of the Secure Exam Browser on your device well ahead of your scheduled exam to ensure it will work. If it does not work, you may have to find another computer on which to take the exam.
  • Broadband (DSL, Cable or T1)
  • 256Kbps or higher per workstation

Some level of encryption must be in place for wireless networks while the exam is in progress. SSL can be supplemented with another security protocol, such as but not limited to WEP, WPA or WPA2.

A secure exam browser is required to administer the Aquifer Pediatrics, Aquifer Family Medicine, and Aquifer Radiology exams; this application “locks down” the computer and prevents students from accessing other software applications during the exam. The secure exam browser will also detect any programs running on the student’s computer that could compromise exam content.

The secure exam browser application requires administrator rights to install.

Schools must confirm that each computer has the secure browser installed prior to the exam.

NOTE: THIS IS NOT REQUIRED FOR INTERNAL MEDICINE EXAMS

Download the secure exam browser.

Students using personal laptops should be advised to arrive early to detect any problems with their local firewall.

Extra workstations/laptops should be available to replace computers that may malfunction during the test session. These spares should be enabled for wired and wireless LAN use.

* Adapted from the NBME Quick Start Guide to Web-Based Exam


Technical Support Staff Responsibilities

Individuals serving as technical support for an exam are expected to ensure that all computers being used for exam administration can deliver the exam securely and successfully.

In advance of administering the exam, we recommend…
  • Set up a dedicated workstation/laptop in each testing room that will used by the proctor in that room.
  • If you would like to run a sample test to verify the secure browser has downloaded and is working successfully, please contact [email protected] to request a test login for your institution.
It is the responsibility of the technical support staff to…
  • Have knowledge of the operating system (OS), virus checker and browser version that reside on institutional workstations/laptops or examinee laptops.
  • Be knowledgeable about the network architecture of the testing rooms.
  • Verify that Internet connection speed is adequate (minimum T1) for the exam.
  • Be available to be onsite on the day of the exam to resolve technical problems that may arise.

Exam Support

If an issue arises during the exam:

    1. Contact your institution’s technical support staff.
    2. Access Aquifer Exam Troubleshooting Tips.
    3. If neither of those addresses the issue, contact Aquifer’s exam support staff weekdays 8 am – 8 pm ET, except federal holidays.

Contact [email protected] or (603)-277-2060 with any questions about test administration activities.


Security Reminder

Please remind all faculty and students that all exam content is confidential and should not be shared with anyone, at any time, in any way.

Create an Exam Roster


In Aqueduct, Course Administrator users are responsible for exam standards, utilization, and identifying learners who will require access to scheduled assessments.

If you’re a Course Administrator, please follow the instructions below to create an exam roster which can then be downloaded and forwarded to Aquifer’s exam management team. You will find resources for successful exam management here.

Please note that a Custom Course is required in order to utilize Aquifer Exams. Learn how to set up a Custom Course.


How to Create an Exam Roster

  1. FROM WITHIN YOUR CUSTOM COURSE: Choose the More Actions button on the top right-hand side.
  2. From the Course Management page, use the right-hand column to select those users who will need to be rostered into the exam.
  3. Please verify that your list is correct before moving onto the next step – Review the list of student emails. Please ensure that no student is listed as UNKNOWN UNKNOWN. If they are, please contact those students directly and have them complete their registration. Students not registered are ineligible for exams until they have completed their registration.
  4. When all students are correct, Choose Exam Roster button in the top right-hand corner.
  5. An Excel CSV file with a roster of these students will download onto your computer.
  6. Attach the downloaded file to your Exam Request Form.
  7. You can expect to receive a confirmation email that the roster has been received and is being processed.
  8. Approximately one week in advance of your exam date you should expect to receive an exam guide for each student with their individual password and sign in information from [email protected]
  9. If you have any questions or concerns, please direct all inquiries to [email protected] or call the exam helpline at (603) 277-2060.

Securing Your Exam

To ensure a private and secure exam environment, Aquifer requires its online multiple-choice exams to be administered on computers configured with a secure exam browser. A secure exam browser temporarily restricts the computer from using any other browser for the duration of the exam, preventing the access of other websites or files. The secure exam browser application used by Aquifer is called Safe Exam Browser.

For Students

If you plan to take an Aquifer exam using your own desktop or laptop, you will need to spend a few minutes installing and testing the Safe Exam Browser. This applies to students taking exams for:

  • Aquifer Family Medicine
  • Aquifer Pediatrics
  • Aquifer Radiology

To help ensure a successful online exam experience:

  1. Verify your device meets the minimum technical requirements for the Secure Exam Browser to successfully download.
  2. Install and test the Safe Exam Browser days or weeks in advance of your exam to allow time for troubleshooting if needed.
  3. Be sure to complete the steps in the order listed below.

Before the Day of Your Exam

Follow these steps to install software that will prevent access to other websites or files during your exam. These files are only intended to be used while you are testing the Safe Exam Browser or taking your exam.

Download the appropriate Safe Exam Browser application for your operating system using the links below. You will be asked whether you want to save the installer file. Choose yes. This file may be saved wherever you like.

For Windows Users:
  • Download the Safe Exam Browser from this link: Safe Exam Browser for Windows
  • Double click on the SafeExamBrowserInstaller.exe file and follow the installation steps. Give the installer any permissions it needs.
For Mac Users:
  • Download the appropriate Safe Exam Browser from this link: Safe Exam Browser for Mac
  • Save the SafeExamBrowser-2.1.3.dmg file and open it (it may open automatically).
  • Drag the Safe Exam Browser icon into the Applications folder in the mount window that matches the screenshot below.

  • Make sure you don’t have another Safe Exam Brower.app version 2.x in the Applications folder of your Mac already (your config file may open the wrong version).
  • Create a folder on your desktop labeled “Aquifer Exam” to keep this start file in so you can locate it easily when you are ready to take the exam.
  • Click this Exam Portal link to begin download.
  • The download will begin in the bar at the bottom of your screen.
  • Close your download bar after the portal has completed, by clicking the X to the right on the bar.
  • Open your downloads folder and search for “Aquifer_Exam_Portal_v1.seb”
  • The Exam Portal file will have an icon that looks like this:
  • When you locate that file, drag it or move it to the folder on your desktop labeled “Aquifer Exam”, and leave it there until you are ready to test the Safe Exam Browser.

After installing the Safe Exam Browser, we recommend taking a few minutes to test it with your device before the day of your exam.

  • Click on the “Aquifer_Exam_Portal_v1.seb” file to launch the short sample exam.
  • When you reach this screen, use these case-sensitive login credentials to sign in:
    • Login: Test123
    • Password: password
  • Once you enter the platform, select START to begin the short sample exam.
  • Complete the 2-question sample exam. At the last question, choose to END TEST.
  • Click YES to submit the exam, and use the CLOSE BROWSER option.
  • If you receive a pop-up asking to leave the Safe Exam Browser, please use the QUIT option.
  • You are now prepared to take your exam on your device.

If for any reason the Safe Exam Browser does not seem to be working for your device, you can simply perform a hard shutdown of your device to disengage the Safe Exam Browser.

A “hard shutdown” is continuously holding your power button until the machine completely powers down. The operating system will generate options to shut down with a pop-up, but you should ignore those and just continue to hold the power until the machine goes completely off.

Once the machine is powered off, you can turn it back on and resume regular use.

If you are still having issues, please contact Aquifer Exam Support.


Taking Your Exam

  1. Open the folder on your desktop that you created labeled “Aquifer Exam” and find the Exam Portal file that looks similar to this:
  2. Double click the icon to open the Safe Exam Browser application.
  3. The browser will ask if you want to Quit or Start. If you are ready to take the exam, choose Start.
  4. The Exam Portal page will look like this:

5. Use the assigned login and password your proctor has given you to start the exam. This is a password assigned for this exam and is not your regular Aquifer login and password.


Having Trouble?

For Administrators & Educators
For Students

Contact Exam Support Monday through Friday 8 AM to 8 PM Eastern time, except federal holidays.

Exam Troubleshooting

For Aquifer Pediatrics – Aquifer Family Medicine – Aquifer Radiology Exams

Student results are sent to the clerkship within two business days. Aquifer does not share results directly with students.

Often students will attempt to log back into the exam platform after their administration is over. If a student is “stuck” at the login page, they will need to perform a hard reset of their device in order to return their device to off the Secure Browser. They can be instructed to do a hard reset, or they can be referred to call the helpline.

Aquifer sends two reports with students results from their exams. One is the Administrator’s report, and the other is the Student’s report. For those institutions that desire to give individual reports to students there are a few ways to do so:

  1. Print the entire document and disseminate individual paper hard copies to students directly.
  2. Create individual PDF’s for each student: Open the document and hit the “print” icon, select # of the pages (the student report is 2 pages per student, so 1-2, 3-4, 5-6, etc), click the PDF button at the lower left, save as PDF, and change the name of the PDF(to the student’s name) and save it in the correct location on your computer. When you have done this you will have an individual PDF for each student, and can send them as an email attachment to students directly.

Additional Support

For further assistance, please call the Helpline weekdays Mon-Fri 8am to 5pm Eastern Standard Time, except on federal holidays at 603-277-2060 or email at [email protected]. Extended support available till 7:00 pm Eastern Standard Time weekdays on days when exams are scheduled. If you receive a voicemail, please leave a name and number, someone will return your call as soon as possible. 

Reporting for Students


It’s fast and easy to view your progress through Aquifer cases. From your course page, students see a progress bar showing their progress through each case in the course. This display also shows the date last accessed for each case.


For more detailed information—or to download and save your progress—we recommend using the Student Report for each course. The Student Report simply and clearly illustrates your progress in a course, including the following information:

  • Case Number
  • Time from Case Start to Complete (Total time in hours, minutes, seconds)
  • Percent Case Completed
  • Pages Completed
  • Start Date (local time)
  • Date Last Accessed (local time)
  • Completion Date & Time (local time displayed on screen, Eastern Time displayed in exports)
  • Case Summary statement (if applicable)
  • Case Reset Status

How to Generate a Student Report

It’s easy to generate a student report in Aqueduct from your course page:

1. Choose the Student Report button on the right-hand side.


2. The generated report will appear.

Your progress through a case is shown in real-time as:

  • Case Complete = Green Check Mark
  • Case Partially Completed = Yellow circle showing the percentage of the case complete – Note: the percentage does NOT a grade or score!
  • Case Not Started = Red Circle
  • Case Reset = Any color circle with a black outline

You Can Export a CSV File: All reports can be exported to a CSV file, which will allow you to sort and save your course progress. The export button is located on the right-hand side of all reports pages. All times will appear in Eastern Time on exports. Please note that times appear in local time on-screen.

Export Notes:

  • All times appear in Eastern Time on exports. Times display in your local time on-screen.
  • The number of times a case is reset appears in report exports only.

Completing a Case

Cases are complete when you click the Finish Case button in the Case Summary Download section at the end of each case.

If you have completed the case content but don’t see the Finish Case button, be sure to answer all three required feedback questions at the end of the case. After you have completed the three feedback questions, you can access the Finish Case button and the downloadable case summary.

If you do not complete the feedback questions and click the Finish Case button, your work will show as partially completed—as a yellow circle showing the percentage complete—on Aquifer reporting for both you and your instructor.

User Roles & Permissions

In Aqueduct, your program will have complete control to manage your users and assign permissions in a way that fits your structure. Our system is built to offer a range of permission options to best suit your program’s needs.

Setting Up a New Subscription

Before you begin setting up your Aquifer subscription, please review the roles and permissions for each user type and decide who will fill each role. From there, it’s easy to add users, assign permissions, and manage administrators in Aqueduct. Please note that each user may be assigned to only one role in Aqueduct.


Checking Your Aquifer Role

Your program will determine your role and permission level in Aqueduct when you are added as an administrative user. Your role is stated in your initial email invitation and is listed on your “My Profile” page in Aqueduct. If you need to create Custom Courses or access student progress reporting but do not have the appropriate role, please contact your Program Service Administrator. If you are not sure who fills that role at your institution, please contact Aquifer Support.

The Program Service Administrator is the primary subscription manager for the program and has the highest level of permissions in the system. This is a required role. There can only be one Program Service Administrator for each program. Users in this role:

  • Serve as Aquifer’s primary contact regarding subscription renewal
  • Add administrative users to the system and assign roles and permissions, including assigning a Curriculum Administrator, IT Manager, and other key administrative roles as required by your program
  • Manage (add, edit, and remove) all users—students and administrators
  • Determine who will upload student rosters. Students must be rostered in Aqueduct to gain access to Aquifer courses, and this can be done by the Program Service Administrator, a separate Student Roster Manager, or by the Curriculum Administrator. The Program Service Administrator should decide who will perform this role, and make sure they are assigned a role in the system and are prepared to upload the student roster
  • Access the searchable Case Library to easily sort and filter cases and quickly view case synopses and learning objectives
  • Full authorization for tracking and reports at the program, course, case, and student levels
  • Highest level in the permission hierarchy—the Program Service Administrator can perform any role within the system as fits your program, including creating custom courses, viewing student cases, adding/deleting other educators, and perform any other role

The Curriculum Administrator serves as the overall administrator for the educational content and has access to all courses and reports. This role is optional, and is often assigned to a Curriculum Dean and his/her Coordinator/Administrator. New programs are given permission to add up to 3 Curriculum Administrators to their program. These users may identify and oversee subscriber program standards for incorporating curricular content into courses, including use for grading and assessment. Users in this role can:

  • Manage (add, remove, and edit) most administrative users (Student Roster Managers, Course Administrators, Course Managers, and Teachers) and all student users
  • Access all program, course, case, and student reports
  • Create custom courses
  • Access the searchable Case Library to easily sort and filter cases and quickly view case synopses and learning objectives
  • View ungated case content—with the ability to see answers to embedded assessments, advance through a case, and access the case summary at the end of a case without having to click through each card or complete each answer as required in the student role

The Course Administrator is often a Course Coordinator, Site Director, or delegate. and/or their coordinator who has course-level responsibility. Course Administrators can create customized courses to assign specific cases and students to courses, and view cohort and individual performance across courses. New programs are given permission to add up to 2 Course Administrators for every paid Aquifer course they subscribe to. Users in this role can:

  • Manage (add, remove, and edit) Course Managers, Teachers, and Student users
  • Create custom courses to align with their course or block rotation, assigning specific cases and specific students to the course
  • Access course, case, and student reports for Aquifer courses as well as for specific custom courses which they created or have been granted access.
  • Create exam rosters—Course Administrators are the only role that can create exam rosters. If you need permission to add additional Course Administrators to your program to manage this role please contact us so we can help you
  • Access the searchable Case Library to easily sort and filter cases and quickly view case synopses and learning objectives
  • View ungated case content–with the ability to see answers to embedded assessments, advance through a case, and access the case summary at the end of a case without having to click through each card or complete each answer as required in the student role

The Course Manager is responsible for tracking student progress and completion within a course. This role is consistent with Clerkship or Course Director. New programs are given permission to add up to 4 Course Managers for every paid Aquifer course. Users in this role can:

  • Create custom courses to align with their course or block rotation, assigning specific cases and specific students to the course
  • Access the searchable Case Library to easily sort and filter cases and quickly view case synopses and learning objectives
  • View ungated case content—with the ability to see answers to embedded assessments, advance through a case, and access the case summary at the end of a case without having to click through each card or complete each answer as a student needs to.

Teachers (preceptors, didactic instructors, etc.) have ungated access to Aquifer courses, meaning they can view the student cases, the answers to embedded assessments, and the case summary without having to click through each card in a case content or custom courses to which they are invited. Teachers can view all the Aquifer courses your program subscribes to. Additionally, if they are assigned to a custom course they can view that content as well. Teachers do not have access to view reporting. There is no limit to the number of Teachers that a program may add to the system. Teachers can:

  • Access the searchable Case Library to easily sort and filter cases and quickly view case synopses and learning objectives
  • View ungated case content—with the ability to see answers to embedded assessments, advance through a case, and access the case summary at the end of a case without having to click through each card or complete each answer as required in the student role

The IT Administrator serves a supportive role, helping to whitelist your program’s specific domain to ensure users receive automated email messages and addressing firewall or other implementation issues as needed to facilitate access. New programs initially have permission to add one IT Administrative user. This is a required role. Users in this role can:

  • Reset user passwords
  • Verify user permissions
  • Resend email invitations to administrative and student users
  • View all administrative and student users

The Student Roster Manager is an optional role that can upload and manage student rosters for your program. Depending on how you chose to manage your subscription, the Program Service Administrator or Curriculum Administrator may upload student rosters, or you may assign it this role to a separate Student Roster Manager, perhaps in the Registrar’s Office. New programs initially have permission to add one Student Roster Manager user. Users in this role can:

  • Upload student rosters
  • Manage (add, remove, or edit) all student users
  • Schedule and re-send student email invitations
  • View program level reports on course and case usage

The exam proctor is the individual who supervises students using Aquifer Exams. This person can be any qualified individual who the clerkship approves to supervise test-taking students. The exam proctor is not a specific role within Aqueduct.
For Internal Medicine Key Features Exams:

This individual has the responsibility of:

  • Starting the exam for each student utilizing the exam proctor dashboard
  • Pausing the exam utilizing the exam proctor dashboard, if necessary
  • Communicating with Aquifer’s exam support stuff if any issues arise during the exam

Resetting Your Password

1. If you forget your password, Aquifer can help you regain access to your courses and information right away. From the Sign In page, click the Forgot Password link.


2. You will be brought to a page where you can enter your Account email address. After entering your email address, click “Send me instructions to set my password“.


3. You will receive an email with instructions to reset your password. If you do not see this email, check your spam mailbox. Follow the instructions in the email to reset your password. Click the link to reset your password.


4. You will then be brought to a page where you can reset your password. Please put in your new password twice to confirm and click on “Change my password”. You will then be logged in with your new password.

Student Progress Reporting


Tracking Student Usage and Performance

Aqueduct provides easy access to a range of interactive report dashboards. Program Service Administrators, Curriculum Administrators, Course Administrators, and Course Managers can all access reports on courses, cases, and student performance. Reports can be viewed online in the interactive dashboard, or downloaded and exported to a CSV file.

video

The Aqueduct Reporting Experience

It’s quick and easy to find data by student, case, or course. Our reports are simple to generate and easily understood. Reporting features include:

  • Generate real-time data on student progress through a case, shown as:
    • Case complete = green check mark
    • Case partially completed = yellow circle showing the percentage of the case that is complete. Note, the percentage does NOT represent a grade or score!
    • Not started = red circle
    • Any color circle with a black outline = indicates that the student reset the case
  • View student Case Summary statements next to the Expert Comment summary statement for easy evaluation.
  • Search For a Specific Student: You can use the Search function to search for a specific student by entering the student’s name into the search box
  • Sort: You can also click the column headers in reports to Sort report results by student email, first name, or last name.
  • View student case resets to see if a student has reset the case, if this information is important for your program.
  • Export a CSV File: All reports can be exported to a CSV file, which will allow you to sort and manipulate the data as you wish. The export button is located on the right-hand side of all reports pages.

Case Completion Notes

Students must answer all three required feedback questions at the end of each case—and click the Finish Case button in the Case Summary Download section—in order for the case to appear as complete on reporting. If students have worked through the case content but haven’t completed the feedback questions or clicked Finish Case, their work will show as partially completed—a yellow circle showing the percentage complete—on all Aquifer reports.


Reporting by Course Type
  • Aquifer Signature Course Reporting: Reports for Aquifer courses that come standard with your subscription include student progress in the course for every student that is registered in the system. (Note: These reports can get large if your program has registered a lot of students and may include students who have not been assigned to work in the course. We recommend creating custom courses to access tailored reporting).
  • Custom Course Reporting: Creating a custom course is a recommended step for programs that wish to access reports tailored to a specific set of students and/or cases. Custom course reports include results for only the students and cases assigned to the course. Optimizing your reports is just one of the many reasons to create a custom course—learn more.

The Course Report

The Course Report provides a quick view of students’ progress through each case in a course.

To access the Course Report:

  1. Choose Courses from the main menu.
  2. Select the desired course.
  3. Click on the Course Report button on the right side of the screen.

The Course Report will appear, including the following information:

  • Email Address, First Name, Last Name for each student. For standard Aquifer Courses every student who has registered in the system will appear. For custom courses, only students that have been assigned to that course will appear, regardless of whether they have registered in Aqueduct. Students who have not yet registered in Aqueduct will appear as ‘Unknown Unknown’.
  • Total number of cases completed by each student.
  • Progress through each case in the course shown in individual columns, as shown as a green circle for cases that have been completed, a yellow circle for cases in progress with the percent of the case completed, and a red circle for cases that have not yet been started. Cases that have been reset by the student will show with a black outline around any color circle.
  • Hover over the blue icon next to the Case name and number to see the full name of the Case.

The Case Report

The Case Report shows the progress that all students have made within a specific case within a course.

To Access the Case Report:

From within your Course Report, you can access case-specific reporting in just one easy step:

  1. From the Course Report: In the header row, click on the case number you need to access.

For each student, the Case Report includes:

  • Time from Case Start to Complete
    • Note: This calculation was updated in Nov 2018 to improve accuracy.
  • Percent of the Case Completed and Case Reset Status
  • Pages Completed
  • Case Start Date (local time shown on-screen)
  • Date Case Last Accessed (local time shown on-screen)
  • Case Completion Date (local time shown on-screen)
  • Case Summary statement (if applicable). If the student is asked to write a summary statement as part of the case you will be able to view his/her submission here. The Summary Statement column will be blank if the student has not written a summary statement and will show N/A if there is no summary statement question within the case.
  • Expert Comment summary statement (if applicable) for easy evaluation of your students’ work. Note: Scroll to the right to view this column.
  • Exports: All information shown on the screen is available for download in a csv export. Please note that times will appear in Eastern Time in exports (and local time on-screen).
  • Note: The number of times the case was reset by each student will show in the Case and Student Report exports only.

Managing & Removing Administrative Users


After administrators are added to your program, it’s easy to manage your administrative users in Aqueduct. Users with administrative user management permissions (view roles and permissions for details) have the ability to:

  • Remove administrators from your program
  • Export an administrative user list
  • Edit administrator user roles
  • Send email invitations to administrators at any time
  • Sort and filter administrators in a variety of ways

The Administrative User Panel

The administrative user panel provides at-a-glance information and useful tools to help you manage your users.

To access the administrative user panel, click on Users in the top navigation after you have signed in.

Once you have navigated to the Administrative user panel, you’ll notice that the Administrators tab will be activated automatically. Please note that student users are accessed separately by clicking on the “Students” tab.

administrators user panel

The top of the Administrator User Panel displays your admin user counts at a glance, listed by their assigned role. Counts include:

  • Registration Pending: The number of admin users who have access to your program but have not registered in Aqueduct yet
  • Active: Administrators who have completed their registration
  • Total: All admin users currently rostered in your program (both registration pending and active)
  • Max: The maximum number of admin users that may be added based on your institution’s current subscription

You will also see Send Email Invitation, Export User List, and Remove Selected Members buttons. These three options are inactive until users are selected.

All users are listed at the bottom of this page and may be sorted, filtered, and exported in a variety of ways.

There are a variety of options available for sorting your administrator list. Below your admin user statistics, you’ll see a full list of your admin users with a variety of options for filtering, sorting and selecting. You can Search (1) by last name, first name, or email address in the search field.

Aqueduct’s admin user panel allows you to Filter by Role and Filter by Status. Use the dropdown menus to sort the list of admin users below by Aqueduct role assignment or registration status.

administrative user filter search and sort options

You can also sort in ascending or descending order by first name, last name, email, role, clinical discipline, and date added (2). Please note first name, last name, and clinical discipline is entered by users when they complete their registration and will not be available for administrators who have a status of “Registration Pending”. The role field indicates the role assigned to the user in Aqueduct.

To sort, click on the button for the field you wish to select (3). The button you select will turn a darker blue while your sort is active, and a pointer will appear next to the text indicating if your list will be sorted in ascending or descending order. Click the button again to change the sort order.

In order to use the administrative user management tools, you will need to select a user, or group of users, you wish to manage. After using the filter and sort options to display the list of users as you’d like, there are two methods to select and deselect students.

  1. Use the Select All Shown or Deselect All buttons above the list.
  2. Check the box next to each administrator you wish to select. Check the box again to deselect.

Selected admin users are highlighted, and show a checkmark in the box next to their name.

administrators select and deselect options

Administrative User Management Tools

Our user management tools make it quick and easy to edit and export users, or send email reminders to your unregistered users.

Changing the role assigned to an administrative user is easy.

Next to the user you want to edit, select the Edit Role button.

edit admin user role

This will open a page entitled Edit Role for [user’s name]. Choose the appropriate role from the drop-down menu by clicking on the up and down arrows. Click Update.

edit administrator user role page

You will be directed back to the Users page for your program. A message will be open at the top of the page indicating whether or not you have successfully added users, “Group role was successfully updated.”

administrator role updated success message

Note: If your program already has the maximum number of users for a role (viewed form the main user panel), you will not be able to add additional users in that role. Please contact Aquifer support for assistance.

Email invitations can be sent to administrative users with a Registration Pending status at any time. Please note that all admin users automatically receive an email invitation when they are initially added to the program. You may wish to send reminders to administrators who have not signed in to access your course after a few months, or a period of time that fits with your program’s schedule.

Email invitations will ONLY be sent to users with a Registration Pending status.

To send an additional email invitation, select the users you wish to email, and click the Send Email Invitation button.

admin send email invitation

You will receive a pop-up prompting you to confirm that you wish to send an email to the selected users. Click OK to continue sending the email invitation.

email invitation message

After emails are successfully sent, you will see a confirmation note in the light blue box at the top of the page.

invitation emails sent

Please note: Emails will not send to users with an Active status. If you select users with a mix of statues, emails will send to only those who have not yet registered. After clearing the pop-up, the message at the top of your screen will show which emails were sent to users.

To export a list of users to a csv file, select the admin users you wish to export and click the Export User List button. Your browser will direct you to download and save the csv file for your use.

export user list with highlighted users

Removing Administrative Users from Your Program

Removing admin users from your program will discontinue their access to your Aquifer courses and reporting. There are two ways to remove admin users from your program.

To batch remove admins using a list of email addresses, click the Remove Admins button at the top of the page.

remove admins

On the Batch Remove Administrators from Program page, add emails (comma separated) for the users that you wish to remove from your program and click Remove Administrators.

batch remove admins screenshot

You will receive a pop-up message asking to confirm the removal of the listed administrators. Click OK to confirm that you wish to proceed.


After the process completes, you will see a confirmation in the light blue notification bar at the top of the page.

You can also remove administrators by selecting them from the user list, and clicking on the Remove Selected Members button. The options for sorting and filtering your user list allows for efficient use of this method for removal.

remove selected student users

You will see a pop-up notification asking you to confirm deleting the selected users. Click OK to continue.

remove selected members success

After the process completes, you will see a pop-up confirmation.

remove selected admin users popup confirmation

Once administrators are removed from a program, they are no longer able to access Aquifer courses or reports.

Creating Custom Courses


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For more control over course management, a customized curricular experience, and tailored reporting, we recommend creating a custom course in Aqueduct.

Why Create a Custom Course?

Organize rotations, blocks, or academic years: Custom courses can be created to align with your rotations, blocks, or academic years, making it easy to assign specific cases to students, track class or cohort progress at a glance, and include course specific information or directions for students

Align Courses to Your Curriculum: Optionally, you can pick and choose cases to create courses that fit your curriculum. You can create courses that align to integrated clerkships, bootcamps, electives, or specific student’s remediation needs. You can integrate cases from our free course, like Diagnostic Excellence, with a discipline-specific course that you subscribe to, enriching an existing course.

Track and monitor progress for a specific group of students: Reports for custom courses are tailored to include just the students and just the cases assigned to that course, making it easy to track and monitor student progress in the course at a glance.

Manage Exam Rosters: Creating a custom course is a required step for subscribers using Aquifer exams, and allow for quick and easy exam roster creation. Please note: A Custom Course is REQUIRED if you are using Aquifer exams.


Create a New Custom Course

Do you want to copy a set of cases or users from an existing course to a new custom course? Save time by using our new Duplicate Course feature, which allows you to copy cases and/or users to a new custom course. If not, continue with the directions below to create a new custom course.

1. Click on Case Library in the top navigation, or the Create Course button on your courses page to access the Case Library page.


2. Use the Advanced Case Search to select the cases you would like to add to your custom course. Note: Skip this step if you want to create the custom course shell first and add cases later or create an exam roster.


3. Click Create Course.


4. You will see a pop-up message confirming that you want to create a custom course from the selected cases (or confirming that you want to create an empty custom course). Click OK to continue.


5. On the New Course page, enter:

Course Name: We suggest using a consistent naming convention that includes course and rotation name, such as “Family Medicine Clerkship: Block 4”.

Description: We suggest including instructor name, instructions for the course, which cases are assigned, due date, and anything else your students need to know.

Person Responsible: Select the user responsible for the course from your list of eligible administrators. The person responsible will be visible on the course page to all students and administrators associated with the course and will be notified when the course reaches its end date to either delete or extend the date of this course.

Start Date: Visible to all course users.

End Date: This date will show on the courses page for all associated users. When the end date is reached, the person responsible for the course will be notified and asked to delete or extend the date for this course.


6. Click Create Course.


7. On your new course page, you will see your course information at the top and the cases you have selected showing below.


Add Users to the Course

Only the users that are added to custom courses will be able to view and access it, so it is important that you complete this step. All users assigned to a custom course will receive an automated email invitation. You can add or remove users at any time.

Remember: Users must be rostered in your program before you can assign them to a custom course.

  1. From the custom course page, choose Course Users button in top right-hand corner. This will take you to the Course Users page.

You have two options to add users:

Add by Email will allow you to batch add the students to the course, rather than adding them one by one from a list, and is recommended if you have a large group of students to add to a course.

1.Click Add By Email in the upper right-hand corner.


2. Insert comma separated email addresses into the open field. It is recommended that you have list of student emails in a column list (in Excel) which you can simply copy and paste into Aqueduct.


3. Select a date to schedule an email inviting users to access this course. If you do not choose a date, the email invitation will send immediately.


4. Click Add Users button directly under the field.

Add by List allows you to select users to add to your course by selecting them from the list of current users in the system. This option is recommended if you are adding individuals or small groups of students to a course.

1.Click Add By List in the upper right-hand corner.


2. Scroll through list to find specific users or use the Search feature to search for a user by name or email. Please note that if “Unknown Unknown” appears to the right of the student email address, they have not yet completed registration or signed in.

3. Click on a user to select them.


4. Select a date to schedule an email to your users inviting them to access the course. If no date is selected, the email will be sent immediately.

5. Once you have completed your selection(s), choose Add Members button in top right-hand corner.

Confirm Your Users Were Added Successfully

1. A message will appear at the top of the course page indicates the users that were successfully added to the course.

2. If you receive a message saying “The following emails are not members of the group yet but were saved to be added to the course later ….” It means the system does not recognize those emails as having been previously rostered. Check to see that you entered the email addresses correctly. If so, contact your Program Service Administrator to ask to have the users rostered in Aqueduct. Once they have been rostered in Aqueduct they will be automatically be added to the course.


Course Users” to view all users that have been added to the Course.


Automatic Invites

Users are automatically invited to custom courses: The user(s) you have selected will receive an email stating, “You are receiving this email because you have been added you to the course [Course Name] in [Program Name] from Aquifer.” with a link to log in.

Rostering Students in Aqueduct


In Aqueduct, it’s easy for administrators to manage student access. The most important thing to know is that students need to be rostered in Aqueduct in order to have access to the Aquifer courses. Be sure to add new students to your program at the start of each academic year or semester.

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Notes about Student Rosters:

  • Please inform students that you will be using their official institutional email address only. Using official institutional emails exclusively allows a consistent way for you and students to manage log-in, and for Aquifer support to assist students who need help.
  • The format for inputting a student roster is comma separated email addresses ONLY. You will want to download this list from your current system to a CSV file.

Access the Student User Panel

To access the student user panel, click on Users in the top navigation. From the program users page, click on the Students tab.


Details on the student user panel can be found in our Managing and Removing Student Users post.


Adding Students to a Program

From the student user panel, click on the Add Students button at the top of the page.

add student users button

Copy/paste your student emails in comma separated format on the screen. You can also add new students one by one throughout the year as needed by simply typing their email address into the box.

batch add students

If you would like to schedule an automated email inviting your students to access your program’s Aquifer subscription, click on the checkbox next to the “Send invite emails to students” text. If you do not want to send automated email invitations at this time, don’t check the box and click on Add Students. You will have the ability to send email invitations at any time once your students are added to your program.

batch add students and choose date for email invitation

If you wish to send an automated email invitation, a date selection field will appear after you check the send invite box. Schedule your email invitation by selecting the date on which you would like it to send. If you select the current date, your invitation will send immediately.


You will see a confirmation at the top of your User page listing the user(s) that have been added. If you have included any student emails that are already part of the program, you will see a red notification bar with that message.


The students you added will now appear in the student user list below as “Unknown Unknown”, showing their email addresses and a status of “Registration Pending”. When the students sign in and complete their registration, their status will change to “Active” and this screen will show the values that they enter for First Name, Last Name, and Anticipated Graduation Date.

student user panel

To learn more about student user management and tools, please view our Managing & Removing Student Users post.

Integrating Aquifer Cases into Your Curriculum

Effective, successful integration of Aquifer cases into the curriculum depends upon careful consideration and planning.

Proven Integration Strategies Include:

Creating clear learning objectives from the Aquifer cases that link to your course objectives
  • Articulate clearly to students how the case learning objectives fit into the overarching learning objectives for the course.
  • Discuss the use of Aquifer cases in student orientation materials.
  • Require student completion of the cases or a relevant subset of cases.
  • Fill gaps in clinical exposure with virtual patients – count completion of the case toward clinical case log entries, which assists in meeting LCME standards as well.
  • Include case content in formative or summative assessment.

Incorporating time into your curriculum for the Aquifer cases

Research has demonstrated that the most effective integration strategy is building in time for students to work on the cases.

  • Eliminate redundant teaching from didactic sessions, required reading, other course assignments or unrelated assessments.
  • Schedule time for students to work on the cases during the course.
  • Ensure sufficient access to computers and the internet, particularly during clinical assignments and away rotations.

Blending Aquifer content into clinical teaching
  • Ask clinical faculty to review case summaries for common presentations, building on the content before or after clinical encounters.
  • Compare and contrast the presentation of Aquifer cases to students’ own patients.
  • Encourage teaching residents to draw from the case resources – they likely completed the cases as students themselves!
  • Use the Aquifer clinical reasoning structure to frame and expand discussions of patient workup and management.

Building on Aquifer content in didactic sessions
  • Align required case completion to your course didactic sessions.
  • Use Aquifer cases to guide sessions on required competencies: communication skills, professionalism, cultural competency and systems-based practice.
  • Create active learning sessions––such as team-based learning or flipped classroom sessions––that require students to problem-solve and apply what they have learned.

Creating new learning experiences that elaborate on Aquifer content

Educators have reported a number of innovative methods for expanding on Aquifer content––taking clinical learning to a higher level:

  • Clinical reasoning assignments
  • Patient safety and quality improvement exercises
  • High fidelity simulation exercises
  • Standardized patient sessions
  • Reflection writing exercises

Sharing Innovations

Do you have integration strategies that have worked well for you? Do you have teaching innovations that you’d like to share? Contact us. We’d like to disseminate them!

Engaging Your Faculty with Aquifer

With Aquifer you can tell your busy teachers to relax–you’ve got the core content covered! Now they can do what they love best: teach about patients, observe students’ skills, provide useful feedback, and mentor students’ professional development.

Realizing the full value of Aquifer occurs when students blend their learning from our cases effectively into their foundational knowledge and clinical experiences. Your clinical faculty, community-based preceptors, didactic faculty, and teaching residents provide invaluable opportunities for this cognitive integration to occur.

Eight Great Tips for Teaching with Aquifer

We offer a variety of password-protected access options:

  • Student-level access: Includes card-by-card case navigation with a case summary provided upon case completion. All faculty, community preceptors, and residents who share your institutional email address may self-register for all of the courses to which your institution subscribes.
  • Teacher access: Includes open case navigation, access to the case summaries, and to the case search feature of the Aquifer website. Contact your institution’s Aquifer Program Service Administrator or Curriculum Administrator to authorize access.

Our case summaries provide an in-depth review of each case––the learning objectives, the differential and final diagnosis, and key teaching points. All of the summaries are available to registered instructors in the relevant Aquifer course. Encourage your faculty and residents to:

  • Familiarize themselves with the Aquifer cases that are common to their practice setting.
  • Incorporate relevant Aquifer case content into their didactic session.

Our site is optimized for mobile access, making teaching on-the-fly easy. Your teachers may quickly find relevant cases or case content through our powerful search feature found on the Courses page.

  • Website search (open to the public): Searches the Aquifer site for relevant content, including the virtual patient presenting problems. Preceptors and residents can encourage students to complete Aquifer cases just prior to or following clinical patient encounters.
  • Case search (available to registered instructors only): Searches the virtual patient cases themselves, identifying all relevant content and multimedia within the cases and case summaries. Preceptors and residents can dive into the cases at a moment’s notice, drawing immediately from the rich resources that the cases provide.

Encourage your clinical teachers to visit our Educators page and use our integration resources to:

  • Compare and contrast the presentation of Aquifer cases to students’ patients.
  • Draw from the wide array of available multimedia resources and Web links for use in their own teaching.
  • Employ the Aquifer clinical reasoning structure to frame and expand patient work-up and management discussions.
  • Use the case analysis tool to work through an Aquifer case together––or apply the tool to a challenging patient presentation.
  • Apply the Aquifer summary statement rubric to students’ real-time case presentations.

Residents can be unsure in their new teaching role. Remember––they probably completed the cases as students themselves! Now they have access to the instructor resources. Urge them to draw from the cases they found most useful, and to use Aquifer’s Educator Resources as a way to get started.

Clinics get busy. Admissions mount. Faculty and residents struggle to balance it all. Students worry about finishing this week’s cases. Problem solved! Increase your teacher and student satisfaction by letting them know it’s OK to give students some time to work on the cases when the day gets out of hand. How often is it that easy?!

Decrease lecture time and increase active learning in your course or clerkship when you integrate Aquifer content into faculty or resident teaching sessions.

  • Align required case completion with your course didactic sessions––and cut down the need for your faculty to lecture. Ask them to do a chalk talk instead: We guarantee the students will enjoy it a lot more.
  • Expand on Aquifer content about the competencies that are more effectively taught in face-to-face discussions, including communication skills, professionalism, cultural competency, and systems-based practice.
  • Create active learning sessions––such as team-based learning or flipped classroom sessions––that require students to problem-solve and apply lessons they have learned from working through the virtual cases.

Educators have reported a number of innovative methods for expanding on Aquifer content––taking student satisfaction and clinical learning to a higher level:

  • Clinical reasoning assignments: Create and solve new “what if” scenarios built off of our virtual patients.
  • Patient safety and quality improvement exercises: How would you measure the quality of the care received by an Aquifer patient?
  • High fidelity simulation exercises: Create scenarios that make our virtual patients take a turn for the worse.
  • Standardized patient sessions: What would happen if this Aquifer patient could talk?

Flipping the Classroom with Aquifer

Aquifer cases can be used very effectively during classroom flipping exercises. The cases can provide a means of learning the “facts and concepts” in the subject so that students can build the foundational knowledge that they need.

The teaching time with students either individually or in clerkship groups can be used to:

  • see how they can extend those concepts to related cases;
  • investigate areas of uncertainty or controversy; and
  • assess the depth of knowledge and/or reinforce key learning objectives.

By using them in this way, students’ understanding of the case can be assessed, built on, and integrated into patient management.

More about classroom flipping

Contribution by Petra Lewis

Classroom flipping (also known as the backward classroom, or reversed classroom) reverses the traditional roles of in-classroom teaching by an instructor and self-instruction out of the classroom by students. Instead of students learning facts and concepts in class, and then applying them while working through problems or cases at home, the students learn the facts and concepts outside of class–often using technology via recorded PowerPoint™ or whiteboard lectures, online modules or websites, but also through prescribed readings from textbooks or articles.

Classroom time with an instructor is devoted to application, integration, and reinforcement (i.e., the top of Bloom’s Taxonomy, see below). This increases active learning and student engagement, improves understanding, and allows the instructor to both assess and correct knowledge and conceptual gaps with the student in real time as opposed to correcting an assignment.

Classroom flipping has been applied from elementary through post-doctorate programs. For more resources on the web, look for work by Eric Mazur and Salman Khan. The Khan Institute contains over 4,000 videos covering a wide variety of disciplines and educational levels that can be used for classroom flipping.


Key Considerations

  • Pre-learning needs to be appropriate for and focused on the in-class work.
  • Students should be given sufficient notice about classroom flipping activities and assignments (e.g., “The teaching session next Thursday will be based on CLIPP cases 23 and 24, and these must be completed prior to that session”).
  • If pre-work is not done, learners can learn in class, but may not be able to lead a small group session or contribute much.
  • Be careful not to overwhelm learners with the quantity of pre-learning (recommend keeping to under 1 hour).
  • If videos are used, keep them short (< 15 mins.).
  • Consider learner preferences (e.g., watching whiteboard videos versus reading an article). You may need to provide options.
  • Consider a short pretest to assess the level of knowledge retained from the pre-learning activity (using audience response pads works well but is not vital) or incorporate a Q&A session.
  • Use the results of this assessment to define the areas that need to be explained differently or in more depth.
  • Try to structure the activity to a higher level of Bloom’s taxonomy.
  • Make the activity as specific and as personal as possible.
  • Classroom activity can involve individuals, pairs, or groups. You may want to adjust the group size to pre-learning completion and variability of expertise in the group.
  • Use questions based on the upper (4, 5, 6) critical thinking skills defined by Bloom’s Taxonomy (http://www.celt.iastate.edu/teaching/RevisedBlooms1.html). Use different examples of the same conditions/situations/histories to see how students can apply the knowledge or skills they learned (“far application” of learning).
  • Take the basic concepts learned further; have students apply them to a more complex case.
  • Include feedback about the quality, quantity, and comprehensibility of the pre-learning material.

Some students take time to adapt to a classroom flipping environment, particularly if their prior education has used more passive pedagogies. If the “upfront” work is not done, students may feel uncomfortable or get little out of the active session and may not even attend. A policy that requires attendance may occasionally be needed.


Suggested Classroom Flipping Exercises

Flipping the classroom can be done in a variety of ways.

  • Assign specific cases for students to review before a clinic that is likely to have one or more patients with these disorders (e.g., asthma, COPD). Using appropriate patients as the focus points, see how the student can integrate the key learning points from the case into patient assessment and management. Ask about differences and similarities between the actual cases and the Aquifer cases.
  • Use the Aquifer cases in place of some of the didactic lecture material. Assign students cases containing topics you would normally cover during that didactic session and use the classroom time to go deeper into the topic–to discuss different but related cases or to discuss one or more of the assigned cases in more detail.
  • Use the Aquifer Pediatrics Questions for Further Consideration as a basis for the classroom sessions in pediatrics.
    • Team-based learning “light”: Assign the QFC (higher order Blooms) application questions to teams; assign the same question to all teams
    • Assign similar but different QFCs to different groups. Have the students teach each other at the end.
  • Question pairs: Have one student ask another student a question based on something they learned from the case.
    • Questions should be developed during the pre-work. Students may need encouragement to make sure questions are not too simple.
    • Consider asking students to submit written questions, which you then randomly assign.
    • Can they write a question based on another case they know on this topic?
  • Poll-repoll with ARP (Nearpod, PollEverywhere, clickers): Have students respond to a multiple choice question individually, then allow 2 minutes for discussion of the answer with a partner, then ask them to resubmit their answer. This works especially well with a large group.
  • Structured controversy: Recent changes in preventative health management, imaging, and screening. Debate both sides of the question.
  • Jeopardy: This is a good exercise to consider for the end of the clerkship after students have reviewed a number of cases. Categories may be based on particular cases or topics.
  • Polling type questions: Use questions in the cases that have more than one right answer. Ask students to defend their answers or critique the alternatives. Can be used with groups, pairs, or individuals.
  • Compare and contrast 1: Ask students to compare/contrast certain disease presentations and treatments.
  • Compare and contrast 2: Ask students to compare/contrast the “real world” with the virtual patient and evidence-based medicine. (i.e., Can you think of a time in this rotation that a patient presented/was treated differently than this virtual patient?)
  • Have students write a case-let (mini case) on a given topic.
  • “What if?” applications for the local system: Ask students to work out local systems for common problems (e.g., antibiotic sensitivities, social services, finding medication doses, etc.)

Aquifer Radiology Active Learning Modules

Aquifer Radiology has seventeen workshop modules that can be used in a classroom flipping setting by radiology educators. These assess and extend the key learning objectives from the cases using different images and clinical scenarios.


Aquifer Pediatrics Active Learning Modules

Five learning modules for use in conjunction with Aquifer Pediatrics cases are available for your use. These application exercises, complete with facilitation guides, have been thoughtfully prepared with the aim of minimizing teacher preparation time and maximizing learner achievement. Learn more…

Salman Khan talk at TED 2011

Lage M, Platt G, Treglia M. Inverting the classroom: A gateway to creating an inclusive learning environment, Journal of Economic Education. 2000

Prober CG, Khan S. Medical Education Reimagined: A Call to Action. Academic Medicine,2013; Vol. 88, No. 10.

Orienting Your Students to Aquifer

Today’s students are digital natives and require no formal orientation to our virtual patient software (Aqueduct) – just send them the web link and they’ll take it from there. 

We encourage you to review—and share with your students—our Student Experience page and Student Story Videos. Including the link to the Student Experience page (https://aquifer.org/students/) in your orientation materials will help students understand how Aquifer cases can help them advance their skills by providing complete, realistic clinical experiences.

Anytime, Anywhere Access

Be sure to let your students know that all cases are available via our mobile apps. Download “Aquifer Clinical Learning” for iOS and Android to complete work anytime, anywhere—including working offline.

Key Questions for Effective Orientation

Orienting students to your rationale and use of the cases in your curriculum is important to achieving effective integration. Review the following questions during your course orientation, or include the questions and your answers in the course materials.

Review the Aquifer educational goals with your students and articulate how you have chosen to incorporate them into your own course goals. Discuss how the cases will advance their understanding of the foundational concepts and clinical skills within your course.

Many educators require students to complete all of the cases within an Aquifer course. Other approaches include assigning specific cases to fill an important gap in clinical experience or in faculty teaching expertise or assigning a specified number of cases of the student’s choosing.

Students are encouraged to complete the remaining cases as needed. You may also wish to make your students aware of the additional courses that Aquifer offers with each subscription.

Regardless of your approach, ensure that your students clearly understand your expectations at the beginning of the course.

Most educators choose to use our student reports feature to monitor students’ case progress and engagement. Many document case completion to meet institutional case log or LCME requirements. Be clear with students at the beginning of your course that you will be monitoring their progress, and how and when they will be notified if they are falling behind, or devoting insufficient time and attention to the cases.

To assist students in pacing themselves through the cases, many educators assign a minimum number of cases to completed each week. Additionally, best practice suggests requiring students to complete a specific case prior to a didactic session or related clinical experience. Ensure students understand that case completion is a requirement and will be monitored through the student log report.

Our cases are very effective for self-directed learning and independent study. However, proactive students can further their understanding by intentionally integrating their learning from the cases with their clinical experiences. Consider suggesting these methods during your orientation.

  • Completing or reviewing Aquifer cases just before or after seeing a patient with a similar presenting problem.
  • Comparing and contrasting the presenting finding from an Aquifer case with their patients’ presentation.
  • Applying the Aquifer clinical reasoning approach to their patient presentations and write-ups.
  • Using the Aquifer summary statement rubric when writing summary statements in the patient record.
  • Reviewing their questions about the cases with their preceptors or teaching residents.
  • Applying practice guidelines identified in the cases to their own patients.

Our research has shown that intentionally building time into your course for students to work on the cases is a critical integration factor (Berman et al, Academic Medicine Academic Medicine 84(7):942-949, 2009). Identifying and listing time to work on the cases in your course calendar is a straightforward method to make this time clear to students.

Integrating assessment closes the curricular loop and demonstrates to students that you value the Aquifer content and their time spent working through the cases. We offer a variety of formative and summative assessment methods directly linked to our case content and pedagogy. An early understanding of how their Aquifer work will be assessed ensures student attention to the cases, and enhances their engagement.

Aquifer Pediatrics Active Learning Modules

Aquifer Pediatrics Active Learning Modules are application exercises designed for educators to use with their students in small or large group settings. These modules have been thoughtfully prepared with the aim of minimizing teacher preparation time and maximizing learner achievement.

What is an Active Learning Module?

An active learning module is a type of facilitated student-centered learning session that promotes students’ ability to apply core concepts and information learned from pre-session assignments to new and more complex scenarios. Active learning modules typically consist of between one and three case vignettes, or “application exercises,” each followed by one to four questions that stimulate the student to combine and apply the learned concepts in new ways. Each question requires the students to do one or more of the following:

  • React to a clinical scenario
  • Interpret laboratory or other diagnostic data, or
  • Respond to other previously unseen information

Students should then have to make a specific choice or create a specific answer to the question.

Answers to these questions should not be found in the pre-assigned Aquifer Pediatrics cases (or in any other resource assigned in the pre-lesson homework), and can only be answered by synthesizing and applying the information learned to reach a single best answer.

Students should be expected to make decisions and use their judgment.

Application exercises simulate authentic clinical scenarios—with appropriate ambiguity and uncertainty—and allow each student or student team to reasonably select a different “best answer” provided they are able to support their answer with reasonable arguments based on the concepts provided in the cases and other advance preparation assignments.

Active learning modules can be used for:

  • Flipped classrooms
  • Team-based learning
  • Small group sessions

Using the Modules

There are currently active learning modules for:

  • Pediatric immunizations
  • Fever
  • Prescription writing/Patient safety
  • Child development: Identifying and classifying speech delay
Each module contains:
  • A detailed facilitator’s guide: This guide is designed to allow the course director to map the learning objectives to the course curriculum and to understand the expected learning outcomes. In addition, it is designed to provide the granular teaching points and higher order structure needed to allow an instructor novice to use the information to teach a session successfully.
  • Pre-session homework assignments: One to three Aquifer Pediatrics cases will be assigned in preparation for the session. Additional reading requiring less than 30 minutes of preparation will also be assigned.
  • Individual and group readiness assessment questions: A series of questions to administer to the students at the beginning of the learning session in order to hold the student accountable for the assigned pre-reading. If using team-based learning, the questions will then be repeated as a group.
  • Core concepts: Core concepts are the building blocks of clinical decision-making. They are the concepts that allow students to tackle novel clinical scenarios. These are the concepts that we want students to take away from the session.
  • Specific learning objectives: The learning objectives are the measurable outcomes for how a student demonstrates mastery of the core concepts.
  • Application exercises (in both PowerpointTM and pdf formats): The application exercises are complex clinical scenarios that stimulate students to apply the core concepts that they have learned through their pre-reading. They should require students to work together to come to a solution.

Where to Find the Active Learning Modules

The Pediatrics Active Learning Modules are available to educators and administrators with current subscriptions to Aquifer Pediatrics or Aquifer Family Medicine. To access this resource, sign in to Aqueduct and navigate to your Courses page. Click on the green Educator Resources bar. The Active Learning Modules are available for download in the Pediatrics Educator Resources section.

Aquifer Radiology Flipped Classroom Workshops

Enhance your students’ knowledge about radiology through Aquifer’s interactive Radiology Flipped Classroom Workshops. These modules were developed by a group of nationally recognized radiology educators and shown to influence student learning.


Included with your Aquifer Radiology subscription:

video

Flipped Classrooms are meant to be interactive learning sessions with the students (in a non-threatening setting for student participation) to reinforce materials covered in the case. Students like the Flipped Classrooms as an alternative to didactic lectures. It also gives them the opportunity to ask facilitators about any problems they had with the case.

There are 18 Flipped Classrooms corresponding to 18 Aquifer Radiology modules and Educator materials available on how to use Flipped Classrooms, what the concept of Flipped Classrooms entails, and how to implement them (video demonstrations, references, etc.). This is a great resource if you have never used the Flipped Classroom or are unfamiliar with the concept.

All Flipped Classroom cases have excellent radiographic examples, pertinent annotations, and are appropriated to the materials covered in the case. All modules are in PowerPoint format, with material embedded in the Notes of PowerPoint. This information is provided to the facilitator for each PowerPoint slide (what questions to ask students, the answers to the questions, what learning points to emphasize, etc.). This is not visible to the student when projected on the screen in PowerPoint. This allows any facilitator (from resident, fellow, to staff radiologist) to facilitate a great interactive session. Providing questions (and answers) to the facilitators should make them comfortable doing these sessions. Of course, the facilitator can ask own questions, etc. The notes are meant to provide a guide to the facilitator.

Educators can choose to add some of their own cases, delete examples, etc. It is essential that the student complete the Case prior to the Flipped Classroom. The Flipped Classroom reviews the pertinent learning materials using radiographic case examples. It is meant to be an interactive learning session with student participation. They are designed to last 60-90 minutes.

Documentation of teaching is important in many medical schools for faculty evaluation and promotions. Faculty who use these prepared Flipped Classrooms can document teaching time with medical students. Some medical schools will require a student evaluation of the presenter and this can be done by each institution’s policy.

Aquifer Radiology Cases and Flipped Classroom Workshop resources can be used to “Flip” your classroom, and make precious instructional time more productive and valued.

  1. Educator resources include:
    • Flipped Classroom pedagogy concepts
    • 18 Aquifer Radiology Flipped Classroom Workshop files
    • Video demonstration of Radiology Flipped Classroom
    • Pointers to implement your own Flipped Classroom teaching
    • References (links, including to the Aquifer grant supported work by O’Connor EE, Fried J, McNulty N, Shah P, Hogg JP, Lewis P, Zeffiro T, Agarwal V, Reddy S. Flipping Radiology Education Right Side Up. Academic Radiology, published online April 7, 2016. doi:10.1016/j.acra.2016.02.011. PMID: 27066755. This effort won the 2017 AUR Herbert M Stauffer Award for Best Educational Paper published in Academic Radiology in the year 2016

Aquifer Radiology Flipped Classroom Workshops:

    • Can be completed in a 60-90 minute session
    • contain excellent case images and annotations, chosen to emphasize learning outcomes in the corresponding Aquifer Radiology online case
    • are in PowerPoint format
    • flexible for educators’ adjustment to needs specific to their setting
    • include facilitator guidance for what to ask (with correct answers), what to emphasize, and active learning tasks to use for interactive classroom engagement in each workshop
    • lower the barrier for recruiting medical student educators, including radiology residents, who need teaching to fulfill program ACGME requirements
    • Promote far transfer of learning by providing opportunity for learners to APPLY what they learned from the online Aquifer Radiology cases to new examples

Outcomes with Aquifer Radiology Flipped Classroom Workshops:

  • Depend on prior student completion of the Aquifer Radiology online case
  • Ease documentation of faculty & resident teaching activity
  • Students love the Flipped Classroom as an alternative to traditional lecture-based didactic instruction
  • Interactive aspect of instruction cultivates better teaching-learning partnerships, as students are empowered/required to interact with instructors, unlike in lectures

Where to Find the Flipped Classroom Workshops

The Radiology Flipped Classroom Workshops are available to educators and administrators with current subscriptions to Aquifer Radiology. To access this resource, sign in to Aqueduct and navigate to your Courses page. Click on the green Educator Resources bar. The Flipped Classroom Workshops are available for download in the Radiology Educator Resources section.

Using Aquifer for Formative Assessment

Providing students with continuous feedback about their performance is an important aspect of effectively blending virtual patients into the curriculum. Additionally, LCME accreditation standards require that students receive timely formative assessment of their problem-solving, clinical reasoning, decision-making skills, and their learning achievement. Our cases provide feedback on student knowledge throughout the case and through self-assessment questions which are associated with the courses.

Formative Assessments in Development

We are excited to share that innovative new formative assessments are now in development. The new test-enhanced learning tools will deliver granular feedback with recommendations for efficient, structured remediation and self-directed study, and a modified option for summative assessment.

NEW FORMATIVE ASSESSMENTS


Summary Statement Feedback

Identifying, interpreting, and summarizing key findings is a fundamental clinical skill. Our summary statement feedback tool enables you (or your designated faculty) to review student created summary statements within the cases and easily compare them to summary statements written by content experts. Integrating this feedback mechanism in the clerkship will allow you to provide your students with concrete feedback, helping them to improve their clinical reasoning in a meaningful way.


Case Analysis Tool

Assess your students’ clinical reasoning development and provide individualized feedback. Using the case analysis tool requires students to apply critical thinking skills independent of the virtual cases, and allows you to assess students’ clinical reasoning process and provide individualized feedback. Answer keys are available for the Aquifer Pediatrics cases. Learn more…


Aquifer Internal Medicine Clinical Decision-Making Exam

Included with Institutional Subscriptions

Supplement your formative assessment with this innovative approach. This unique online examination focuses on students’ clinical decision-making and serves as a complement to the Aquifer Internal Medicine virtual patient cases. The exam was developed by a group of experienced medical educators under the guidance of Dr. Georges Bordage, an expert in the key features approach.

Clinical Decision-Making Exam

Case Analysis Tool

The Aquifer Case Analysis Tool is a structured worksheet to be completed by the student as they work through an Aquifer case, designed to enhance the development of clinical reasoning skills. Although built for Aquifer Pediatrics, the Case Analysis Tool can also be used with Aquifer Family Medicine, Internal Medicine, and Geriatrics cases.

The Case Analysis Tool also includes:

  • A complete Clerkship/Course Director’s Guide to using the tool
  • A suggested grading rubric
  • Answer keys for many Aquifer Pediatrics cases

The case analysis tool is a simple and elegant way to assist in the teaching of the clinical reasoning process as well as measure students’ learning from Aquifer virtual patient cases. Students’ performance using the structured tool clearly shows not only their understanding of the case material but also their developing knowledge of how diagnostic and management plans are derived. Furthermore, use of the tool enhances students’ learning experience by facilitating direct communication and individualized feedback.


How it Works

A staged process parallels the structure of the cases themselves, as well as the process by which clinicians assess patients. Using the validated case analysis form, the student captures specific requested information in sequence as she/he works through the case:

  • Epidemiology/patient profile,
  • Prioritized problem cues from the patient’s history and physical exam,
  • A problem statement,
  • A differential diagnosis, with each diagnosis supported by specific history and physical exam findings, and
  • A diagnostic and treatment plan, with a rationale given for each step.

The case analysis tool perfectly complements the clinical reasoning features of the cases, taking students’ ability to problem-solve to the next level. Students appreciate producing tangible results of their developing skills to use in discussion and feedback sessions. A few educators have even found it useful for helping students organize their thoughts about their non-virtual patients!

The case analysis tool was developed to accompany Aquifer Pediatrics, but may also be used in conjunction with Aquifer Family Medicine and Aquifer Internal Medicine cases. Answer keys are currently available for most of the Aquifer Pediatrics cases.

The case analysis tool was developed for the pediatric clerkship at Rush Medical College and validated through a joint project between Aquifer and Rush Medical College. Keith Boyd, MD, and Sharon Sholiton, MD, of Rush created a case analysis tool for use with Aquifer Pediatrics cases that provides an assessment tool to evaluate student learning from Aquifer Pediatrics cases. The validation project, funded and managed by Aquifer and led by then Aquifer Pediatrics Editor-in-Chief Sherilyn Smith, MD, further developed the tool to ensure that it accurately discriminates between those who understand the case content and can apply that knowledge in a structured assessment from those who cannot.

As the student works through each case, use of the tool facilitates the development of clinical reasoning skills by clearly delineating the steps involved in the patient evaluation and clinical care through the following steps:

  • The student identifies and documents pertinent data obtained via history and physical exam, and then succinctly summarizes the key information into a problem statement.
  • This focused patient assessment then drives the development of a prioritized differential diagnosis.
  • Finally, the student generates an initial diagnostic and treatment plan.
  • This staged process parallels the structure of the cases themselves, as well as the process through which clinicians assess patients. Using the tool requires the student to develop independent learning skills and allows the clerkship director to assess his/her clinical reasoning process and provide individualized feedback.

Where to Find the Case Analysis Tool

The Case Analysis Tool is available to educators and administrators with current subscriptions to Aquifer Pediatrics or Aquifer Family Medicine. To access this resource, sign in to your Aquifer account and navigate to your Courses page. Click on the green Educator Resources bar. The Case Analysis Tool is available for download in the Pediatrics Educator Resources section.

Using Aquifer Content in Team-Based Learning

Team-based learning (TBL) is an instructional method that fosters a more thorough understanding of concepts versus memorization of facts. Utilizing group work to promote active learning, TBL encourages learners to apply core content knowledge to work through exercises as a team.

Learners actively engage with the TBL format as each team member is held accountable not only to an understanding of the core material but also to contributing to the overall team and in-class discussions.

In the TBL method, learning occurs primarily from team members justifying their answers to each other through the use of application exercises and/or quiz type questions, while faculty serves as content experts. TBL takes advantage of the fact that the collective wisdom of a group exceeds that of each individual in the group.

Aquifer cases, from a variety of courses, can be used for Team-Based Learning.

For example, Aquifer Pediatrics has Active Learning Modules and Questions for Further Consideration that can be used as application exercises. The Basic Science questions, within Aquifer Pediatrics, provide useful prompts for integration of core principles into clinical care in the context of each the Aquifer Pediatric cases. These are basic science “tools” that provide one to two-page refreshers of the scientific principles for teaching clinicians.

Similarly, Aquifer Geriatrics cases can be used for TBL, by having students open a case and work through the case questions as a team.

Resource

Team-Based Learning Collaborative

References

Michaelsen LK, Knight AB, Fink LD, eds. Team-based learning: A transformative use of small groups. Westport, CT: Praeger; 2002

Michaelsen LK, Parmelee DX, McMahon KK, Levine RE, editors. Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. Sterling [VA]: Stylus Publishing, LLC; 2007